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Here’s the tea on mental hospitals (and other things that sound cringey when Olivia says them)…
Never fear, I’m self aware enough to understand my own middle-aged Book Club Mom vibes. A large part of how I became so self aware can be credited to my stays in psychiatric hospitals. There’s a whole lot of stigma and misinformation out there about these facilities. A good chunk of you are likely imagining Jack Nicholson and a pillow at the mention of them. If you’re fresh out of a high school English class it makes perfect sense to associate mental hospitals in this way. Luckily, they are likely not nearly as scary and dangerous as you may be imagining.
However, before I dive in, I want to insert a huge disclaimer in the name of self awareness; I am lucky. I managed to have very positive, formative experiences in some of the best hospitals in the world. Though we got scholarships and other financial help, my family and I were extremely fortunate to be situated so closely to an abundance of top psychiatric resources when my mental illnesses struck hardest. Not only that, but we had overwhelmingly positive experiences with nearly every medical professional we encountered. I know, though, that plenty of people do not have the experience I had. I’m going to try to be as objective as I can in my analysis, but I understand that I’m not going to be able to convey the valid pain of the person who lands in an under-funded and/or understaffed facility, the child who is traumatized by inadequate care, or the incarcerated who should never have been anywhere but in a compassionate medical facility.
If you live in my area (Fairfield County, Connecticut), there are at least 4 major psychiatric hospitals within 20 miles of you. At any given time, approximately 650 of my friends, neighbors, and fellow residents of the New York metropolitan area will be occupying an inpatient bed at one of these hospitals. What kinds of things would bring them there? I asked myself the same question when I first heard of them, knowing nothing but their suspiciously blissful names.
The general requirement for a person to be admitted to a mental hospital is that the person is having a genuine psychiatric medical emergency in which they are an imminent threat to themselves or others. This journey almost always starts at the emergency room of a local hospital. There are many different scenarios in which this can be played out, ranging from a parent driving their child to the ER waiting room to a middle aged person experiencing a full blown manic episode and having 911 called on them. With that in mind, I’ll only definitively speak to the reasons and ways in which I found myself in the hospitals I spent time at. This is a challenging issue to speak about, especially in a public forum, but I see little use in being bashful about what I’ve been through. That, and Prince Harry told me to do it.
In March of my freshman year (around five years ago), my mother drove me to the ER because I disclosed to my therapist that I was considering suicide. My therapist was legally obligated to refer me to a higher level of care once it was determined that I could not be ruled out as an imminent threat to myself. She asked me a simple question in order to determine this, one I assume is commonly phrased this way: “If I send you home, can you promise me that you won’t hurt yourself?” When I couldn’t, she called my mother and told her I needed to be driven to my local hospital immediately.
Once there, I was admitted into the general emergency department before being evaluated by a social worker, who asked me a standard round of questions about my mental and therapeutic history, family history, my medications, and my suicidal ideation levels. I was then transferred to the psychiatric inpatient ward of the hospital, where I stayed overnight in a hospital room like any other. I was far too overwhelmed to pinpoint any particular emotion I was experiencing, whether it be in the moment or now, five years later. In the morning, my family and I were notified that a bed had opened up at a mental hospital that was less than ten minutes from my home. Neither I nor my parents had ever heard of it, but we also hadn’t heard of many of the terms and places that were being thrown around so we quickly agreed that I should be sent there. Setting aside that there was no other option (our local hospital had to transfer me to a psychiatric facility, given what I’d disclosed), we were in over our heads and were eager for any guidance. I was transferred via ambulance, which is almost always how patients are transferred between hospitals, whether the medical condition be bodily or mental. Those ambulance rides were uniquely lonely.
The hospital I first landed at- my very first inpatient experience- was a tough environment. It was the definition of overcrowded, understaffed, and as I quickly learned, had a notoriously poor reputation in the local world of mental health and hospitalizations. These conditions were exacerbated even further during the time I spent there. Hospitals in New York City were so crowded that one had recently, urgently, sent over two buses of mentally ill adolescents. My modestly sized room was home to myself and three other girls, all with vastly different mental illnesses, illnesses that all had differing relationships with aggression. I had spent nearly 48 hours on the campus without having talked meaningfully with my assigned doctors. The adults I had met with were all gentle, kind, and well meaning, but they were in over their heads. We all were shepherded from room to room by recent college graduates, completing menial art projects and rolling around on those colorful, flat platforms with four wheels that they give you in elementary school gym class. A few fights broke out around me and the kids were acutely suffering, with insufficient attention being paid to helping them (not for lack of trying on the part of the spread-thin staff!). While I was gripped and moved by the intense stories my fellow patients were disclosing to me, I knew on my second day that I wanted out. I remember believing that there had to be something more to mental healthcare than what I was getting. I waited my turn for the communal phone, called my parents, and begged them to transfer me. Luckily, thanks to assertive telephoning, geographic proximity, and general affluence, my parents were able to move me to a different facility the next day.
I was extremely lucky. The facility that I was whisked to by whirring, red and blue lights is one of the best in the world. It was also enormously expensive, but I didn’t know that at the time. When I arrived, I huddled myself into a curiously normal armchair in a similarly normal, white clapboard-ed farmhouse on the outskirts of the campus. It was the Admissions building, and I spent an hour or so reviewing my life’s experience with emotion, trauma, and mental illness with an admissions officer there. While we talked, other admissions employees were digging through the belongings I’d shoved into a piece of my mother’s luggage collection, separating anything sharp and removing drawstrings and laces from clothing and shoes (remember those L.L. Bean moccasins that were so popular? Mine were never the same, sans laces). When my interview and the sorting was completed, I was handed my things and an inpatient bracelet. Absent from my things was my Green Bunny, a stuffed animal I’d slept with every night since birth. My eyes welled with tears when they told me that possession of stuffed animals in the inpatient units was prohibited. A few quietly pregnant moments passed before the admissions employee offered me an encouraging smile and told me he’d make an exception this time, but that I shouldn’t flaunt it around the other kids. I stuffed Green Bunny into the bottom of the suitcase and we made our way up to the adolescent unit.
I offer that latter anecdote to emphasize, as much as I personally can, how healthcare in mental hospitals is modeled after empathy. Following the deinstitutionalization movement of the 60’s that was accompanied by waves of discovery of psychiatric medications and evidence-based therapy models, mental hospitals have become facilities dedicated to rehabilitation. While I’ve heard a handful of truly troubling stories, I’ve almost always seen doctors doing their best with life-changing medication, therapy, and collaborative care models, to the extent that their hospital’s resources will allow them. As I was enrolled in school at the time, the hospital communicated with my school administrators, who (to my lukewarm surprise) had plenty of experience with students being hospitalized in the way that I had been and worked with the hospital to build a discharge plan that was gentle and accommodating. I even met a few kids from my town during my stays.
I remained in the adolescent inpatient unit for eleven days. My days were spent on two floors, either in my room (that I shared with a roommate I still am in touch with, today!), meeting with my doctors, in the dining hall, or out in the milieu. The milieu was where various groups were held: horticulture, pet therapy, art, coping skills, DBT. It was flanked by a set of rooms that resembled train station ticket kiosks: a box wrapped in glass, for nurse observation. We went down to the dining room three times a day, where we picked at genuinely well made meals that few of us had any interest in, as well as a variety of snacks, teas, and hot chocolates that were on the unit at all times. My roommate and I snuck handfuls of Fig Newton packages into our room and hoarded them in a drawer (this was intended to be in secret, as food in rooms wasn’t allowed, but they surely knew about it and we were never called out). In off hours we’d gather around the TV and watch sports or a movie. The kids were of all ages and types- between fourteen and seventeen, preppy, “emo,” athletic, addicted, sober- and most of us were eager to let everything out. In order to arrive on the couches we were all splayed upon (or curled up into), we’d all had to endure a great deal of suffering, to the point where we were desperate for any relief we could cling to.
The hospital, for most of us, was that relief, at least for a little while. I was prescribed four new medications and was discharged with a plan for a PPT meeting at my school and entry into an adolescent DBT talk-therapy group with a new therapist. It was the kind of radical, spurted change that many folks respond well to. Plenty of the patients who came and went through that unit only needed a week or so to stabilize and get back on track. In a way, I did respond well to my time there. I loved and needed the people I met and it started me on the right track. However, I found myself back in the same facility in May, two months later, following a full blown suicide attempt. I was taken to my general hospital in an ambulance and there was much more tearful resistance involved in the process. I spent a month in residential care, newly medicated and working diligently with my high school to stay on top of work while recovering, and it was only when I emerged in June that I was truly ready to safely and autonomously face the outside world.
Today’s mental healthcare system, thanks to the Americans with Disabilities Act, is modeled after an imperative that treatment be the “least restrictive possible.” The goal of the system is to find a way for the mentally ill to function manually and with as little oversight and treatment as possible, as soon as possible, as cheaply as possible. With the exception of the latter, mental hospitals are a crucial step in many folks’ journey to that point. Don’t get me started on insurance coverage…
Though data on suicide attempts is not collected in an official capacity, as many as one in ten youth report having previously attempted suicide at some point in their life, and it can be assumed that almost all of those attempts involved subsequent hospitalizations. Dangerous situations and resulting mental hospitalizations are happening all around you, to people you know, likely to someone you love, at some point. My hope is that this account of my former experience in the world of psychiatric hospitals will help broaden your understanding of the hardships those around you face, whether it be a hypothetical acquaintance or a loved one. Though mental hospitals indisputably have their issues, they are not weird or just for crazy people. For many, they do a whole lot of good. I absolutely owe my life to them, and we all owe civic gratitude to them.