1. indy5live
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    indy5live Active Member

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    Mental Institution

    Discussion in 'Setting Development' started by indy5live, May 15, 2012.

    In an attempt to improve my novel (a lot less telling and more showing), I'd like to come up with various mental conditions that can be put into one of three wards at the hospital (for minors):

    Each patient of the institution is assigned a ward and depending on what ward they are assigned to, they have different regulations and restricts in terms of who is allowed to go where and when. If you are housed anywhere in Ward C, you're either considered dangerous to yourselves or otherwise dangerous to anyone around you, thus twenty-four hour attention and special treatment is given to these patients, which often includes being heavy sedated with medication or being strapped down to a bed while the doctor’s transport them around to do various clinical test on them. All the residents of Ward C have their meals delivered to their quarters and are never granted permission outside of their ward, so food carts are constantly leaving the kitchen through the cafeteria in their direction.

    Ward B patients, however, are free to roam about their designated area without restraints as long as they remain on good behavior, but all activities are closely monitored by nurses around the clock. The kids that make up this ward aren't particularly dangerous; they are just on trial medication and could lose their sense of control without notice, sending them into a tantrum that would make a kid hyped up on energy drinks look like an altar boy. Like just a few minutes ago a thirteen year old girl from Ward B just threw her entire lunch across the room and made a big mess because she thought everyone in the cafeteria turned into zombies. For reasons like this, they are constantly being watched by the nurses around the clock in case an outbreak ever occurs and they have to restrain them. But they are allowed access to the cafeteria and visitation areas as long as their primary doctor grants them permission to do so under close supervision by a nurse.

    And then there is MC's ward, Ward A, which is the most relaxed of all the wards. It's more like an alternative learning center than a hospital, in which the patients here are given a schedule that involves classes, meetings with their primary doctor, meals, free-time and recreation, and they're even allowed to go on the occasional fieldtrip every now and then. Outside of the obvious activities that they need to be closely monitored for and studied by the nurses and doctors, Ward A patients receive the least amount of personnel surveillance during the day. Of course, because of the presents of Ward B patients in areas like the cafeteria, there is usually a nurse close by to jump into action should an incident with a Ward A resident occur. Outside of that, though, the only other type of monitoring the children receive is audio-free video surveillance.
     
  2. shadowwalker
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    shadowwalker Contributing Member Contributor

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    The first thing (if this is set in a real world situation) is that restraints are strictly forbidden (at least in the US). And I believe (but you should double-check) medications for sedative/control use is also heavily restricted, if not forbidden. Clients may be physically subdued at the onset of violent behavior, but are then placed in isolation (yes, the 'padded room') until they have calmed down. In my experience, Wards A and B are actually combined, but there's no reason you can't have the set up as described. (Btw, all clients would be placed in Ward C for at least the first 24 hours after their arrival - just to make sure they are stable enough to be moved to the other ward(s)).

    As to psychological conditions, you have a wide variety of choices, as hospitalization could occur for any condition where the client became a danger to themselves or others.
     
  3. indy5live
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    indy5live Active Member

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    I need ward C to be feared. Like the criminally insane but for children, if such a place exist. The main character gets moved from ward A to ward B and is threatened to be moved into ward C if his condition is actual deemed dangerous to others...
     
  4. Cogito
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    Cogito Former Mod, Retired Supporter Contributor

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    It wouldn't be based on the disorder, but as you say, the danger they represent to themselves and others. Ward C would house the criminally insane, and any patient who is dangerously violent. These are the patients too dangerous to be allowed to be in a common room with other patients, except under heavy guard.

    Ward B would have a common area with monitoring, but would not require guards in the common area at all times that patients are present. Guards would remain ready to be there in under a minute at need, of course. Patients in Ward B could have supervised visits by permission in visit rooms, with prior appointment and permission.

    Ward A would be for trouble but nonviolent patients who are largely functional. This could include some self destructive behavior, so they could still be under suicide watch, but without the urgency of Ward B or C. New intake patients would still probably be under observation in Ward B or C until deemed low enough risk for Ward A. Ward A patients would have visitor lists of people allowed to visit during visiting hours without prior appointments. These groups would participate in more group sessions and fewer individual sessions than Wards B or C, and would have the greatest access to common rooms in this Ward. They would be encouraged to socialize as part of their treatment plan, and may even be permitted weekend passes on the outside, with sign off by their case worker and therapists.

    I disagree with shadowwalker. There are circumstances for which restraints are permissible, to prevent self-harm, even in the US.
     
  5. indy5live
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    indy5live Active Member

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    The institution is from the perspective of a 9-year-old boy...so he observes the ward B patients in the cafeteria but he never sees ward C, he just sees food-carts leaving the cafeteria to an area he hasn't gone. When he ask another child in Ward A what's down there, I want this non-important character to describe a horrible place that children disappear into. If you mess up once you are in Ward B. Mess up in Ward B it's all but game-over for the boy.

    So I guess I don't really need specific disorders, just make examples like: One kid drowned his puppy or set his sister on fire.
     
  6. The Tourist
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    The Tourist Banned

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    Wow, I climbed into a time machine and went back to the 1940s...

    Yikes, there are no such hospitals now in my area. Mendota State Hospital has been closed now for almost 15 to 20 years.

    First off, if a patient is dangerous, he's in a ward inside a prison.

    Second, if you could see mental facilities, you'd be bored from the monotony. Almost all treatment, including the really tough cases, are usually done by out-patient visits. When I was having a very bad ramp-up I asked my wife to take me in. My psychiatrist told me there isn't facilities available for walk-in in-patient care.

    Perhaps in Hollywood for celebrities and in old movies, but not in reality.

    BTW, I'm not going to take offense at this thread, although I should. You wouldn't be permitted to post anything like "modern day share-cropping" or "RICO short-cuts for Sicilians."

    Mental illness is a very real, very debilitating circumstance. It's scary, it's demeaning, and it doesn't need insulting stereotypes. There are enough patients who suffer in silence and do not seek treatment for fear of being treated like lepers. This does not help, and after a reasonable period, I hope this thread is locked.
     
  7. MissRis
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    MissRis Contributing Member

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    This is not true. Restraints are very much still used to protect patients from themselves and other staff.

    What you are describing is not divided by condition, but severity. It is sort of like a prison, this isn't quite the right terminology but it's essentially like minimum security, medium security, and maximum security. It's based on the acute state of the patient. I.e. if staff thing the patient is a danger to themselves or others then they will up the security level.

    And yes, juvenile psychiatric centres do exist, but they are more commonly restrained to specific wards rather than hospitals. This isn't to say that entire juvenile psychiatric hospitals don't exist, they are rare usually due to funding.

    First off, there would be very few "trial medications" being given to children. It just doesn't happen. Psychotropic medications are TYPICALLY restricted to adults and only in extreme cases given to children. But putting trial medication to children just wouldn't happen. However, the behaviour you indicate does happen - even on adult wards. Particularly if a patient is hallucinating or is paranoid.

    And also, the large threats in a psychiatric institution are usually like "padded rooms" (yes they exist) and "solitary confinement-type."

    I would recommend doing some research about psychiatric institutions and different disorders. I would also recommend learning about different types of medications. I can suggest some books if you want.
     
  8. MissRis
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    MissRis Contributing Member

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    This could be different across countries. In Toronto, Ontario, Canada there is a hospital called CAMH (Centre for Addiction & Mental Health) and it provides both long-term, short-term, and out-patient care. They even have built apartments for really acute cases where they live under supervision, but it helps teaches independence etc.

    But Tourist is right, the monotony would kill you.
     
  9. S-wo
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    S-wo Active Member

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    You can read some Batman stuff or play Arkham Asylum if you want some inspiration on an asylum setting.
     
  10. indy5live
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    indy5live Active Member

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    So I need to make it a juvenile prison/alternative learning center that have doctors. Wouldn't require tons of rewriting.
     
  11. The Tourist
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    The Tourist Banned

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    First off, scratch the word "prison," and trash the word "learning."

    We are not prisoners, we are patients. As for learning, it's you muggles that need a remedial education. Bipolars can out-think you with four times the synaptic functions.

    In fact, you personally shouldn't write the story, at all. Find a guy who's willing to do realistic research.
     
  12. indy5live
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    indy5live Active Member

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    Story is already written, lol. (61,000 Words). Just working on making it more believeable. I could bring the story to an earlier time period. Would have to change the part about a blogger making a discovery but that's an easy fix.
     
  13. MissRis
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    MissRis Contributing Member

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    I'm with Tourist here. There are few institutions that help patients beyond getting them on their feet.
     
  14. shadowwalker
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    shadowwalker Contributing Member Contributor

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    Re: physical restraints - it may be this is on a state by state basis then. In Minnesota, it's forbidden. (Any further comments from me will be based on Minnesota, as that's what I know. My apologies for the earlier misinformation.)

    Also, at the state psych hospital I was at, treatment was in-house, not offsite. Outpatient care was not handled by the hospital but through various private/public psychiatrists/psychologists. Also, incoming patients wouldn't be assigned to Ward C if it were for mentally ill criminals; this would be a completely separate facility, and run as a prison first, psychiatric facility second. Also, people may admit themselves via their doctors; they do not have to be committed.
     
  15. The Tourist
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    The Tourist Banned

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    First off, I'm not for censorship. If this is a 'period piece,' like a story inside Bedlam or Bellevue, then showing the past seamy side of mental illness has a place. However, just building buzz on the backs of patients is just sensationalism.

    Not to get on a soap-box to the point of boredom, there seems to be an unhealthy atmosphere on bigotry. For example, you can attack Christians, white people and mental patients as much as you want. If this story or any other was to center the tale with blacks chained to a wall or getting shock treatment you'd find Gloria Allred already on retainer.

    I see no difference for the mental patient demographic. These people are patients, they cannot fight back. Many are hiding. To promote continuing misinformation is not only sloppy research, but a cruelty you cannot begin to understand.

    On several occasions in another forum I disagreed with some resident "golden children." Rather than critique my prose or submit a rebuttal, one guy printed in an open forum, "The biker is off his meds."

    Would we allow people to say, "It is a poor treatise, after all, the guy is black"?
     
  16. MissRis
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    MissRis Contributing Member

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    I'm with Tourist and you will need to tread very lightly and delicately about this topic. There is much too much misinformation spread about mental health patients. And we can't use racial slurs, but it is completely acceptable to call some one "crazy," or "lunatic."
     
  17. indy5live
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    indy5live Active Member

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    Now that I think about it. The mental institution has zero significant to my story. It's just a place I positioned my characters. The MC has a mental limitation, he has a doctor/psychologists that's working with him, and then there is one other character involved with the boy directly outside of his parents. So I can easily create a different environment, as long as there is still a threat of isolation. It would be helpful to have the boy living at the facility but it can be an alternative school of the special students. X-men had their school, the witches had their school...so a gifted mind school?
     
  18. Trilby
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    Trilby Contributing Member Contributor

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    I wholeheartedly agree with all The Tourist's posts on this one.

    Mental illness is an illness not a crime.
    One in ten people suffer from some form of mental illness in their lifetime be it only mild depression. One in a hundred people suffer at some point in their life with serious mental health problems.

    Don't you think it is high time we gave the mentally ill a break.



    The media has a lot to answer for by the use of sensationalism in journalism e.g.

    More people are murdered by sane people than are murdered by insane people yet you will see in the headlines 'Schizophrenic kills...' you don't see headlines stating 'Sane man of sound mind kills...'
    It is time we got the facts right.

    Another thing you are taking about nine year old children - prison?
     
  19. jazzabel
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    What you are describing most closely resembles adult forensic psychiatric institutions, and yes, they are prisons for criminally insane. The only difference is, there are regular mental health assessment board hearings for each patient, and at any point if the psychiatrists feel the patient/prisoner is no longer danger to himself or others, they can release them. In that sense, the incarceration is not limited by time, it has no minimum or maximum duration, unlike ordinary prison sentences.
    Also, they are thought of more as patients than prisoners, by the staff.

    In these places, there usually are three wards - acute (most dangerous), mixed (progressing towards the most "relaxed" ward) and chronic (stable patients, no recent history of violence).

    The risk assessments occur daily, for all patients, there are alarm buttons everywhere, security lock downs, male nurses everywhere, but on the chronic ward patients have basketball court, art room, and yes they roam free, but on the grounds only. Otherwise, the institution is enclosed like a high security prison, with a system of electric fences, check points, at the entrance, only one out of three doors opens at a time, cameras everywhere etc etc.

    As far as physical restraints go, nobody is kept strapped up, but if they are violent, they are sedated and placed into a place of safety ("padded room") and checked every 15 - 30 minutes until they are awake again and calm. Physical restraint at the outset of violent behaviour involves 6 trained nurses, who each immobilise a limb (and a head) so that the patient can safely be given injection of sedative (if they won't accept a tablet or a wafer orally).

    I think you can write any story you want, even if in your world that involves experimentation on children. It's a scary thought, but it is a valid story. As long as it is written well and has a message, it's ok.
    I don't think you should worry about political correctness in fiction. In regular life, yes, the shameful sensationalism and lack of responsibility in the media has lead to gross misrepresentation of mental illness. But that's real world, not fiction.
     
  20. The Tourist
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    Well, it's here we agree to disagree.

    For example, the movie '300' was not historically accurate. But then, it was an action movie.

    But let's touch on an issue that's closer to home. You are a female, correct? Did you know that in Green Bay, Wisconsin, on the Sundays when the Packers lose, the ERs flood with battered women.

    So armed with the same leeway you give the OP, and since I'm from Wisconsin, I decide to write a book about this or a similar topic. And just like the OP, I fudge a couple of details--like I portray several women "that have it coming." Perhaps one character says, "To get the best use out of women and rugs they both should be beaten regularly."

    Now how do you feel about poetic license and niggling details?

    There are millions of topics out there. So do we have to pick one like mental illness to fudge, malign and exaggerate?

    Menopause and PMS are real conditions. Let's switch the topic from mental illness to "crazy broads" who should be locked up for the good of society. Oh, don't worry, not many will wear restraints...
     
  21. jazzabel
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    jazzabel Contributing Member Contributor

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    Hey, Tourist, gosh, I have read a LOT worse than that. If the book you are describing was written so graphically to make people think about why misogyny is bad, I'd really appreciate it. If it was some delusional ramblings of a pathetic wife-beater, I'd not read it.

    To try and censor every idiotic thought that may or may not appear in a fiction novel is not only impossible, but it would make for some dead-boring, pontificating fiction. After all, every nasty piece of work who beats on women can much better explain how pathetic he is by his own actions, then you or I ever could, writing PC literature about "badness of misogyny".
    It's a case of show, don't tell ;)

    Back to my point, forensic mental institutions are not maligning anyone, and writing a well researched novel is the same. Maligning comes from irresponsible journalism that pretends to fairly portray reality but instead, it abuses the facts, employs selective reporting and tries to pass straight out lies and propaganda as the "truth".

    It's them you should have beef with, not fiction writers.

    Lol, if you can come up with a compelling story involving crazy pms-ing broads, more power to you. People are intelligent enough to understand the difference between fact and fiction, and the book section marked "fiction" usually gives enough of a hint as to which is which,.
    And people who are unable to differentiate between reality and fantasy have that problem due to their own mental illness, not because of non-pc fiction literature.
     
  22. MissRis
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    MissRis Contributing Member

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    Fiction is what educates the masses. It's what the majority of people read/watch. It is irresponsible to think that fiction does not affect the perspective of society. If all people know of mental illness is One Flew Over the Cuckoo Nest and Girl, Interrupted then their perspective on mental health patients becomes skewed. Mental illness does not cause violent behaviour. For the most part, people who suffer with mental illness are too far gone to be violent.

    To the OP if the psychiatric institution isn't integral to the story, I would scrap it. I think an alternative learning centre or even a halfway house for juvenile offenders may serve a better purpose.
     
  23. The Tourist
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    The Tourist Banned

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    But that's the issue. It depends on whose ox is being gored.

    To many--far too many--a remote facility for mental patients sounds like a great idea. Look at how many times a crime is committed, and over the morning gossip someone says, "That guy must be nuts."

    A parallel situation exists. Many times I'll be with a group of bikers and someone will tear into a fellow rider and accuse him of being "pussy whipped." In fact, one guy was so bad we referred to him as being "beaver beaten."

    But here's the upshot to the argument. Some one will always say in conclusion, "Well, if she was my wife..."

    Far too many modern men think the answer to our nation's problems is smacking the old lady. You know, like in the good old days when respect still reined.

    Discussing old methods for mental illness is as vile to me as using domestic abuse for a cheap plot-line is for you. Heck, the real events are bad enough. So we have to embroider them?

    If the OP's work is ever put online, copy it to you word processing feature. Every time you see the word 'mental' delete it and type "wife beating." Then read the story again.
     
  24. shadowwalker
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    shadowwalker Contributing Member Contributor

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    I've been fighting a - well, heck sometimes it definitely feels like a losing battle, to get people to quit using derogatory terms for the mentally ill and this has been for nearly twenty years. And frankly, fiction writers are some of the worst for continuing the stereotypes and fear. Just like people watching cop shows and lawyer shows and forensic shows and thinking all of that garbage is true, readers think (unless the story is obviously not real world) that what the author states as fact via the characters is, indeed, fact. Think of all the other negative stereotypes out there that writers would never dream of perpetuating - lazy blacks, slutty women, drunken 'Indians', pedophiliac gays - do I need to go on? Why it's okay to do this to the mentally ill is something I just do not understand.
     
  25. shadowwalker
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    shadowwalker Contributing Member Contributor

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    Not really. Fiction does not mean everything is made up. Fiction is typically based on facts. What the reader doesn't know is which facts the writers is actually using and which ones they have 'tampered with' to fit their story. And readers don't care. If it sounds believable, they believe it. It's unreal how many people thought they knew how to perform CPR because they read a description in a novel or saw it on a medical drama (and this from the certified teacher of the class I took).

    Words have power.
     

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