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June 28, 2020
There are a lot of misconceptions about mental health care, and none of them are necessarily good. Many people hear “psychiatric hospital” and immediately think about padded walls and straightjackets and “One Flew Over the Cuckoo’s Nest.” It also conjures up thoughts of common euphemisms, like “Mrs. Smith went on a ‘vacation’ for a few weeks. She feels much better now.”
Between mental health stigma and the inaccurate portrayal of mental health care in mainstream media, there are a lot of barriers to understanding what really happens when you are admitted to a psychiatric hospital. Want to know what it is really like to be a patient in McLean’s inpatient programs? Read on.
Lisa had become increasingly depressed over the course of several months. Even though she adored her job as a teacher, her illness had reached a point at which she couldn’t get out of bed to go to work. Her family grew worried about her behavior and arranged for her to be evaluated for treatment at McLean.
“When I first arrived at McLean, I just remember that the psychiatrist who first interviewed me was just so calm and nice and a good influence at a time when I didn’t know what was going on,” she said.
During that appointment, Lisa was diagnosed with major depressive disorder and admitted to McLean’s Older Adult Program. Her husband and her niece walked with her to the building where she would spend the next two and a half weeks.
“I was a little shaken walking into the program, with people around, and not knowing what was going on,” she said. “All I remember is my niece was very emotional. She started crying. My husband started crying. I started crying. I just kept thinking, ‘They’re going to leave me here,’ and they did. They did leave me. They had to.”
But in the days that followed, Lisa managed to get out of bed. She took medication that was adjusted specifically for her particular depression symptoms. She attended group sessions with other patients, where she learned she was not alone in her struggles not only with her illness but also with her denial and self-stigma that often comes with living with a mental health condition. She worked each day with her doctors and other professionals, quickly gaining the strength needed to function in her everyday life again.
Once and for all let’s get straightjackets and padded walls out of your mind.
Inpatient psychiatric care is one of many types of care available for those who need help, and is reserved for those who are in crisis. That means that only if you are having severe mental health symptoms that could mean you are a danger to yourself or others would inpatient care be considered for your treatment.
The difference between being in crisis and not being in crisis is fairly simple and is not that much different from when you decide you need to go to urgent care and when you need to go see your primary care physician (PCP). You would not visit your PCP for a heart attack, and you probably wouldn’t visit an emergency room for a common case of strep throat.
Your stay in an inpatient mental health program is as short as possible to effectively treat you and make sure you are safe. You’ll likely sleep in a hospital-style bed. You’ll see doctors, nurses, and other types of licensed mental health professionals. You wear your own clothes (no hospital johnnies here), use your own toiletries, and can have visitors.
There are some things that are different.
Inpatient mental health programs are most often locked. Most people have the misconception that this is to hold people against their will. This is not the case. Programs have locked doors to protect patients. Sometimes it’s to make the patients feel safe (think about a program treating psychological trauma or PTSD), and sometimes it’s to keep patients from getting confused and wandering off of the unit (think of an older adult program where patients may have dementia, or a psychotic disorders program where patients may be having trouble understanding reality).
Diane Bedell, LICSW, program director of McLean’s Clinical Evaluation Center said, “When many people think of an inpatient unit, they’ve never had experience in one. They think of the way it is portrayed in movies or on TV. Patients at McLean are wearing their own clothes. They’re walking around. They often have a shared room with someone, although there are some private rooms, too. It’s not unlike dorm living, in some respects.”
Bedell added that because inpatient treatment is on a locked unit, some patients fear they’ll be locked in their bedrooms at all times. Even though a program is secure, patients are free to walk around, visit staff, and share meals in a common dining area. Patients also have opportunities to go outside for fresh air and can visit with family members or friends for extended periods of time.
There are often restrictions put on what belongings patients can have with them while staying at the program, as there is often a concern that patients might try to hurt themselves. Remember, suicidal thoughts or actions are among the most common reasons someone might need stabilization of their mental health symptoms. Items with cords or those containing glass or sharp edges are not permitted. Patients’ personal belongings are often secured and returned to the patient at the time of release from the program or given to a family member to take home.
Cameras and smart devices are rarely allowed. Beyond the potential danger of charging cords and corded headphones, privacy is of the utmost importance: both that of the patient and of fellow patients being treated at the program.
Parallels to inpatient medical care stop when we look at the process for inpatient psychiatric intake and admission.
Inpatient mental health care is most often initiated by a referral. Sometimes this happens through a psychiatrist or other physician and sometimes through an emergency room. At a hospital like McLean, referrals sometimes come from other programs within the hospital when a patient needs more critical care than their current program offers.
“At McLean, we don’t encourage patients to just walk in, because often our beds are full and this can create disappointment,” said Susan Szulewski, MD, medical director of the Clinical Evaluation Center. It’s important that providers or family of prospective patients call McLean ahead of time to ensure that the hospital has enough beds and that the intake specialists can collect information, such as the patient’s medical history, and confirm their insurance is compatible.
Watch this video to learn more about the admission and evaluation process for inpatient treatment via the Clinical Evaluation Center.
In general, assessment is the first step for any inpatient program. McLean’s Clinical Evaluation Center conducts a robust assessment of the patient to determine which of the hospital’s many programs may provide the best next steps for the patient’s care. The evaluation also marks the first steps in creating a treatment plan to help the individual.
Regardless of the different ways patients are admitted or how hospitals might differ, the goal of every inpatient experience is to provide patient-centered care and support patients in their recovery.
Using McLean as an example, once patients are admitted, they work with a multidisciplinary team, which includes a psychiatrist, psychologist, clinical social worker, and nurse. Care most often includes a combination of group therapy, individual therapy, and medication management. Together, patients and their teams collaborate to develop the best possible treatment plan.
Each inpatient program at McLean has an extensive group therapy program tailored to the needs of the specific diagnosis the program treats. These groups, which meet throughout the day, provide illness education and address skills involving coping with symptoms and stigma.
Lisa says it took her a couple of days to adjust to being in the hospital. She stayed in bed her first day, but the following morning, when she attended a group meeting, “I realized there were a lot of people there who were just like me,” she said. “It was amazing to hear other people’s stories. The stories were different, but there was always a lot that we had in common.”
She recalls one meeting in particular, in which the topic was what to tell other people about experiencing mental illness.
“I was a schoolteacher, and I didn’t want people to know I had depression because I didn’t want that information in the hands of parents of my students,” she said. “It was just amazing to find out there are so many people who are very much like you. And you start to think it’s not a weakness in you. It’s an illness.”
Formal family meetings are also critical to treatment. “As long as we have permission, we reach out to patients’ families,” said Mark Longsjo, LICSW, program director of the adult psychiatric programs at McLean SouthEast. “We are very invested in making sure that every patient has a family meeting. We really see the whole person here at McLean. Mainstream psychiatry and medication are critical to care, but treating the whole person means ‘Hey, let’s find out who your supports are—let’s have that family meeting.’ This is an intervention that’s just as important. I have found that the earlier we do a family meeting, the shorter the length of stay in the hospital.”
Lisa recalls that as she gained strength during inpatient treatment at McLean, she received permission to leave the hospital campus for outings with her family.
“It is such a tight organization, she said. “It wasn’t that you sat around. In addition to group and individual therapy—there were walks, there was music and art therapy, there were a lot of different things going on. Each activity, in some way, was developed to help me and the other patients feel better.”
According to Longsjo, in addition to helping people who need critical care, inpatient treatment expedites care.
“Some of the therapy, some of the family work, some of the medications that are reviewed ... you can imagine how much more aggressive we can be in the hospital than if you’re seeing your therapist once a week,” Longsjo said. “It can take months to do some of the same work that we do here in a week.”
Longsjo acknowledged that reaching the point of doing that work can be challenging for patients. “We understand that this is probably the most difficult time in his or her life, so we respect that,” he said. “We know that it’s a scary process, and our responsibility is to be understanding, welcoming, and allow for the patient to be able to know that we’re here to be helpful.”
Szulewski added that there is a myth about the duration of the hospital stay, which can be shorter or longer than people assume. The length of stay involves the work the patient will do with their primary team at the inpatient program. We can give patients a general estimate of average stays. “It helps reset patients’ expectations to know, for example, that a typical stay for our depression or affective disorders program is 7-9 days,” Szulewski says. “A typical stay for our addiction inpatient program is often shorter and it’s usually 3-5 days.”
Some patients struggle with the stigma of receiving inpatient treatment. “They might be concerned that others would know they’re at a mental health hospital,” said Szulewski. “They worry about how others would find out, what would happen with their place of employment, how information would be communicated,” she said. “We always want to remind those patients of the highest level of privacy that is taken in psychiatric care.”
By law, mental health care hospitals and health care workers cannot release a patient’s information without their permission, unless the release is court-ordered, which is rare. This protection of privacy gives the patient the ability to share the information in their own way when they are ready to do so. If a patient wants a care team to be able to share information with a family member, they must sign a release form granting this permission.
Szulewski added, “An example I like to share with our patients is one in which a patient is admitted to McLean with their spouse, and they both come in together, and we decide together that the patient is going to be admitted. If the spouse were to call later, I would not be able to share information regarding the patient unless the patient signed a release.”
If you or a loved one are struggling with mental health or may be a danger to themselves or others, McLean is here to help.
Call us today at 617.855.3141 to learn more about treatment options, including inpatient care.
“In the general hospital, if you have a friend who is a patient, you can call general information and they’ll tell you where the patient is,” said Bedell. “If someone calls McLean and says, ‘My grandmother’s here,’ ‘My father’s here,’ we’ll tell you we can’t confirm or deny that information, and we take your name and number. If the patient is willing to give permission for you to talk to them, they’ll either give us their permission or call you back.”
While hospital staff cannot share private patient information, that doesn’t apply to the information a family member can share with a patient’s treatment team. Observations from family members and friends are often an important tool to help understand a patient before their hospitalization.
There’s one more thing to cover: the difference between voluntary and involuntary care. You may know it by another name or euphemism—Section 12, pink paper, commitment. These terms are all still in use, but they are less helpful names for involuntary mental health care.
According to Szulewski, one of the biggest misconceptions about staying in a psychiatric hospital is that people are admitted against their will: Most patients in McLean’s inpatient programs are there voluntarily and agree with hospital staff that they want the help. “This doesn’t mean they can walk out of the locked unit at any time,” Szulewski said, “but that they will collaborate with their treatment team to receive inpatient care until they are healthy enough to leave the hospital.”
Involuntary care is such a confusing and sensitive topic—with different laws in every state—that even mental health experts often shy away from trying to explain it in detail.
Patients receiving inpatient care are given the option to voluntarily admit to an inpatient program—just like they would agree to hospitalization for heart surgery.
In rare, but serious instances, there is a legal reason for a patient to require care against their will—though in their best interest. This is considered only when absolutely needed and done in strict accordance with the law to protect the patient.
If a patient is receiving care involuntarily, this changes nothing about the care the program provides to them and very little about their rights, other than, by law, they may not be released from the program without the terms of that state’s procedures being met.
There’s so much stigma and misconception about involuntary hospitalization that it taints the view of most people’s understanding of mental health care in general. It’s not what you think. And it exists only as a way to protect individuals.
Lisa says her hospital stay was “life changing.”
“You learn so much in a few weeks. When you leave, they have a plan for you, so you have ongoing therapy, and they adjust your medication.” She said her outlook when she left McLean compared to what it was before was “day and night. I am very grateful.”
Many patients feel the same way. The Clinical Evaluation Center has a full wall of thank-you cards that patients or family members have written to staff for the help they received when they were going through difficult times.
“Even when patients may not realize what is right or what’s best for them in the worst phase of what’s happening, in hindsight, once they’ve gotten through the experience, they are able to reflect on and appreciate the process,” said Szulewski.
The staff value it too.
“This is my life, “Longsjo said. “Aside from my family, McLean SouthEast means the world to me.”
“It never ceases to amaze me, that a patient at the worst point of his or her life is willing to let me in,” he added. “It’s such a privilege. It’s unbelievable. With the right approach, I get to build an alliance, to build that trust. And the alliance is like no other relationship because it’s short term, but it’s maybe the most intense time in their life. It’s a real privilege.”