Thanks to Uraizen and Oomi for sharing. I generally think that's one of the more important things that goes on in here.
So I read Oomi's story, and I figured I'd type up my experience in the psych ward, a few years back. I'm not trying to present this as some kind of counterpoint - as I said to oomi, I think most people's experiences will fall somewhere between ours. You can receive basically the legal minimum amount of psychiatric care, which sounds more like her experience, or you can get 5-star solid gold celebrity rehab, which is a little closer to what I got. It's especially on my mind as I'm kind of thinking I might be making a return visit soon. I'm not exactly in tip-top shape these days and my family is all up on my buns about not just curling up and waiting for death's sweet kiss, so what can you do? I'm ambivalent - I'm not a danger to myself, but I'm also kind of catatonic much of the day. I definitely need help, and my hospital stay DID help me, but I hated every second of it and I don't wanna go back.
Lemme just say how much my depression-GAF buddies are keeping me going. I perk up a lot when I have people to joke around with. Special shoutout to our ridiculous Neverwinter group. You are all beautiful daffodils and I wanna give you all hugs.
So here's my account of my stay on the psych ward.
Disclaimer that your mileage is gonna vary. The first part of my story is the really unusual bit, but it's still pretty unusual overall. Also, because I had visited the floor I ended up on as a student, I can't help but include a bunch of stuff from the staff perspective. This will be long and rambling, of course, but hopefully it's of some interest.
I wound up on the mood disorders unit for two reasons. First, I have a mood disorder HUR HUR. No, but really, I have a nasty case of depression that I have been trying to treat since most of you were in pampers. SECOND, I had been taking Pamelor, a tricyclic antidepressant, for quite some time and had been doing good but not great. I was reluctant to change it for years and years because it was the best drug I had tried, and I was pretty okay some of the time. So finally I realized that it wasn't magically going to get better in the fourth year of taking it (or whatever it was), so we started something new. Somehow the transition from Pamelor to Effexor just completely screwed me up. It's very hard to come off of a medication that you've been taking for an extended period of time. If you also figure that I wanted to switch meds because I was experiencing one of my down times, you can see that things lined up to make me really sick. I was not sleeping, I was having panic attacks, I felt super sick, and I could barely take care of myself. I missed several days of work, finally went in, broke down crying, and called my doctor.
So here's the weird part of my story. My psychiatrist practices almost exclusively on the inpatient side. He sees me as an outpatient because I was a student at the time. We have a weird relationship where we were doctor and patient, but also colleagues (I'd see him on some of my rotations, or at seminars). I really like him because he does a much better job with this than I'd ever expect. So he'll ask for my thoughts about what I should do next, but he's EXTREMELY knowledgeable, and he always has new ideas about what to do next. And he'll send me out the door with a prescription AND a journal article, so I dig it.
Anyway, if you need to go into the hospital, it usually works like oomi explained. You almost always enter through the ER, where a larger medical center will probably have a special area for psych patients. Instead of putting you in a room with all of the gizmos and usual nursing staff (where you will also usually have to hear all of the other sick people around you barfing and stuff, which sucks), they'll have some kind of dark, nondescript room for you to cry in. The psych resident on call will come down and give you an initial evaluation. Or the ER staff might see you and check out some basic stuff. Either way, you'll wait forever and, if you're enough of a mess, and there is a bed for you, and there is some way to pay for it, etc., you'll eventually get admitted.
So none of that for Bagels. I paged my doc, he called me right back, I said, "I need to go into the hospital," and he said OK, and called me back in 5 minutes. They had a bed for me whenever I was ready. So...that was some celebrity healthcare shit, right there.
Here, psychiatry has its own building, next to the main hospital. It's a huge center, so there are multiple units for kids, old folks, mood disorders, the truly crazy, etc. So the mood disorders unit is like the nicest, most benign one. It's all very clean, the staff is great, the nursing is first-rate (it is very difficult to get a job there, actually). So I just went up to the unit, said, "I'm Bagels," and they had everything ready for me. You have to turn in all your stuff (no belts, shoelaces, phones, and you have to wear awesome grippy hospital socks) and do a partial strip search kinda thing. The rooms are all private, and nice enough, considering where you are. It's a locked unit, and they do safety checks on all of the rooms every how ever much time (more frequently if it's a concern). There's a daily schedule, specific to the group you're in. The floor has a central desk with meeting rooms for the team behind it (it's fucking weird being on a unit you've worked on several times, being on the other side). That looks out on the common area, where we ate, did puzzles, watched TV, read, used the internet, etc. There were three long hallways with patient rooms, with maybe 10 rooms each? and you'd sort of generally be with the folks from your hallway. There were probably 7-10 people who were in my therapy groups and stuff (people were always rotating in and out, so it fluctuated), and I'd see others at meals.
The staff consisted of 4 or 5 nurses, one of whom was your nurse for the day/night. I had maybe four different nurses, total, during my stay, which is unusual. You'd expect more turnover in a place this large, but they really try to keep the same people with you, and they'd transition from days to nights and stay with you. From working on the floor, this kind of continuity of care is an important part of how they do things. On big daily rounds, you'd see a bunch of the staff, but your team would take the lead and make an effort to really get to know you.
So "rounds" in a hospital are really a two (or more) part thing. Usually, the intern/resident on call will do "pre-rounds." The junior staff will have some handful of the patients to watch, and they are expected to visit all of them before rounds actually start to get the skinny on how they're doing, what kinds of tests and things are lined up for the day, and what their disposition is.
So "disposition" is the BIG thing with any hospital stay. On the general medical floors, there are special "dispo rounds" each morning. The foremost thing on EVERYONE'S mind when someone is in the hospital is "when are they going home?" And, on a general medical floor, where many of the patients are elderly, you also ask "where will they be going?" Do people go home home? Into a SNF (pronounced "sniff" - a skilled nursing facility. They're not called nursing homes)? Into a hospital closer to home? Can we arrange home nursing? Etc, etc.
When you end up on a hospital floor, your discharge paperwork is one of the first things created. It's good in the sense that they never plan to just hold you for funsies - they want you to go home basically as much as you want to go home. On the other hand, healthcare sort of operates on the "get them stable enough to go out the door" principle. If you imagine a psych ward as the place to go to get "fixed," you're sadly mistaken. The purpose of the psych ward is to stabilize you so you are well enough for outpatient care. Barring that, longer term care is found in residential facilities (sometimes advertised when you visit this thread!) or, to some degree, via institutionalization. There WAS another unit, for inpatients doing ECT, mainly, or people would get parked on other services (I saw a lot of this on my first medicine rotation) to get combined psych/whatever else care. There just are not a lot of beds for long term care these days.
I'm WAY off track here. Back to rounds. So you'll often be woken up for pre-rounds at some ungodly hour by some junior staffer to answer the same questions you're always answering (lots of rating things 1-10). Then rounds proper begin, where your team sits down in a room and runs their patient list. We had a system that would pull some crap from your chart (meds, diagnosis, allergies), and then had a little extra updating from the residents, giving staff a handy spreadsheet outlining the basic stuff about everyone.
Psych care, at least here, is unusual in that rounds were multidisciplinary. On a medical floor, it was just the docs who did the rounds, joined, if possible, by the patient's nurse when they do the actual walking around part of rounds. In psych, again not at every hospital, morning rounds included the entire team (each floor had a red and blue team, which were teaching services, and I believe a green team, which was not a teaching service). The floor had two social workers, occupational therapy, recreational therapy, the charge nurse, individual nurses as their patients were discussed, the dispo nurse, and the chaplain. One reason why the care is so good here is that everyone who is taking care of you actually meets every day to discuss your case.
So after sit-down rounds, the docs will do what most people think of as rounds, where they'll come talk to you in your room. I got a special deal because I was a student, and there was a good chance I'd know people on the team socially. So instead of medical students and interns and residents, I basically saw my doc, my nurse, and one of the therapists, which was nice. I actually did not see my doc right away, because he was so familiar with my case and he knew I was actually in okay shape, all things considered. I did get some extra attention from the social workers/therapists, I gather as a favor to my doc, who is well liked. I had a few really nice talks with some of the social workers, not so much because I had social work issues, just because they are wise, kindly people, and we got along well. I basically appreciated these talks, again because they knew I was a student and wouldn't talk down to me. At the same time, they saw through a lot of my shit, which was also great. I can talk a good talk, and I like being with people, which I kind of gather makes it easier for me to snow people. It's nice when some dude who haws been in the field for 30 years won't but it.
So a day went like this: you'd try to sleep all night, which was made extra impossible by the nurse checking on you all night (also the terrible beds. I had some powerful sleepy meds on order - chloral hydrate - but that scared me, so I made do with klonopin as needed). They'd come for rounds at 6:30 or 7:00, so thanks for that. Then it's breakfast (which is actually decent here, and you can order each day from a menu) with the other folks (who were a swell lot) before your first group of the day. There was a general group, just kind of going over how people are, CBT group, Occupational Therapy, and then one of yoga/recreation/some other group I can't recall. That last group was usually videos about some specific issue. You were kind of assigned to these, but there was some ability to opt out. There'd be the girl who was always wrapped in a blanket, crying, and it was a big deal when she finally came to one of her scheduled groups.
During free time, you were supposed to interact. I'm SUPER shy (but I also love being around people [once I'm comfortable], so I'm super interesting and unique, obviously), which no one on here seems to buy, and my sense of humor is kind of odd, so it took me some time. I read all of the magazines on the floor and the ONE book I brought (The Bourne Supremacy, for reasons that escape me), by day two, so that sucked. I'm a compulsive reader, so with limited internet access and only a daily paper, I went a tad stir crazy. I eventually got hardcore into working the communal puzzles we had. For some reason, working puzzles seems like the kind of quintessential psych ward activity you'd see in a movie about crazy folks.
You could also do laundry in the evening, and there was workout equipment. I rode the exercise bike as sort of one of those things you do to appease the staff so you can go home.
I honestly really dug yoga - that was my favorite. It makes me think I should get more exercise, as I was always happiest when I was most active. Hmmm...
This is all where this comes out being a little snazzier than most people get. It's a well-funded department at a famous hospital, the staff is generally happy, less overworked than at most places, the facilities are nice, we're not in a big city where you's see more people in REALLY bad shape. There were all kinds of specialized people taking care of you - the yoga instructor did JUST that - she was a legit yoga instructor - they could afford crap like that.
So the groups are fine, I guess. I had done CBT, I know a fair bit about therapy and what depression is, blah blah, so it's wasn't exactly riveting. But I tried to be involved and engaged, so the time passed. For me, some of the interest/disconnect came from me frankly being in better shape than most people on the unit. I have a happy family, I had school, I had my friends watching out for me, I hadn't tried to hurt myself. I frankly probably would not have gotten into the hospital if I had tried just going through the ER, if I'm perfectly honest.
RT was an odd experience. We got to go outside most days and we'd play basketball, or some kind of beanbag toss or some crap. It was nice, because I felt the most like myself and sort of made the most "friends," if you can call them that. I gained a reputation for being "the funny guy" on the unit, which is sort of my deal. That was nice, but I felt dumb tossing beanbags around as some kind of therapy. Like, I tend to be more cerebral about stuff, especially my own mental health. It felt the most...degrading? to be out there tossing beanbags BECAUSE I'M A NUTTER AND PLAYGROUND GAMES ARE MY THERAPY! That was really just my own hangup, though.
You could have visitors every evening, which was great. My wife gave me some space, at my request, up front, because it takes some time to wrap your head around being hospitalized for your issues. She eventually came solo, and then brought my son towards the end. He was a big hit with everybody, especially me, obviously, but I tear up thinking about it. He was too little to understand, but still - going to visit your dad in the mental hospital? He's old enough now that he realizes that "daddy is sad," and "daddy is sleepy all the time," and stuff, and it kills me. Makes me feel like a shit father.
Anyway, my best friend, R, came to visit me, too, which was great. She's been on that same unit twice now, and I visited her every chance I got. She's my depression buddy and we really look out for each other. Having that support, especially from someone who had been EXACTLY where I was, was so powerful. About half of my friends knew where I was (some are just not as good with psych issues, the others all HAVE psych issues

). My wife was great about kind of keeping my visitors down, because I really did not want to see a lot of people at the time. But it was still nice to know that they all wanted to know if they could come and supported my wife while I was getting better. They'd watch our kid, or make her dinner, or buy me dinner (this is the greatest gift when you're in the hospital - receiving real food) for her to bring me. I honestly think the whole thing was harder on my wife than it was on me, so I owe my friends everything for watching out for her.
I spent 7 days on the unit, got my meds stable, worked through some crap in the therapy groups, and just generally got quite a bit better. It hasn't exactly lasted for me, unfortunately. I never, ever want to go back (it wasn't THAT bad, if I think about it, but being super depressed and having people force you to go to groups and crap is certainly painful), but I know it'll come up when I see my doctor the next time. Writing this was partly a way for me to kind of be a little more open to it, if that's what I need. I'm not any danger to myself, but this is decidedly the lowest point in my life, and maybe I need something more than a new prescription. My wife is coming with me to see my doc and, while I can easily soft pedal my problems and put on a brave face, she tends to worry a bit more than I think is necessary. The truth of the matter is somewhere between those extremes, so I'm not sure what my next step is.
That was a tad more rambly than I thought it would be. I'm happy to answer any questions about either working on the unit or being a patient there.