I work on a psych ward...ask me anything

[Anonymous]

Anonymous wrote:

Do most people there get visits from family members?

For kids and adolescents - yes I would say most, although sadly not all. For adults, probably half. Some don't want visitors, others would love visitors but no one comes.

I had to check my six year old into the psych ward. It was the absolute hardest thing I had to do. He was diagnosed with pediatric onset bipolar disorder and was recieving out patient care. He has been in therapy since he was three but he didn't have a diagnosis until he was five.

It took me an hour or more every day, each way, in rush hour, to go and see him. What made it more difficult was that I could only see him for an hour a day. It was a heartbreaking experience.

My son was lucky though. He had visitors every day. There was a day I couldn't make it and his aunt went to see him. I logged in and I saw that my boy was the only one that had visitors. It was four days before there was someone else on the log in because they were taking a child out. I saw one boy call his mom, call times are very restricted, and she said she couldn't talk to him. The poor boy was so upset that he puked.

Thanks OP. Today another child learned of my son's diagnoses and picked on him and called him crazy. This has all been on my mind all day and I was thinking of how well DS is doing since he spent 8 days in the "stress clinic".

Sorry about the rough day, but glad to hear he is doing better. That is a very different model than the child / adolescent unit I worked on. We had a 24 hour open visitation policy and parents could stay 24 hrs if they wanted. Phone calls were 8:30-8:30. Often parents stayed the first night. We did encourage parents not to stay full time as we need time to assess the child without parents around and we want the child to benefit from the therapeutic aspects of the program however if a parent insisted on staying, they were welcome to. We had bed chairs for parents in every room. We were a very family focused unit and parents were part of the team so we expected them to be very involved. Kids often also had extended family, friends, teachers, pastors, community counselors etc visit.

I worked briefly on a unit that was very restrictive in terms of calls/visits but I didn't like that approach at all.

[Anonymous]

Anonymous wrote:


One nice thing about the hospital is never having that uneasy feeling when ending a session with an outpatient who's unstable or suicidal. When working inpatient there's always backup. In community clinics and private practice, not so much.

Absolutely. A great support / back-up team in hospital and team responsibility for decisions. Much less risk involved.

[Anonymous]

My mother-in-law has this superiority/inferiority complex going on that manifests in fits of rage - fulltime rage in the last year - I suppose she is both narcissistic/histrionic. How do I (1) make her never want to speak to me ever again, and (2) make her want to behave around me and my infant child if she won't go away? Thoughts? Maybe you know how I can just get her committed?

[Anonymous]

Anonymous wrote:Have you ever dated one of the crazies?

God this is nasty and hurtful. I bet you wouldn't be speaking like this if you had a loved one with mental illness.

[Anonymous]

Do you think that putting a young child, say 5 or 6, on drugs such as Ritalin or Aderol (sp?), can trigger mental illness? I ask b/c I know someone who's child was diagnosed with ADD at 4 or 5 and he was put on Ritalin and then Adderal shortly thereafter. Aren't those really harsh drugs to give such a young child?

[Anonymous]

8:15 again. I forgot to add that after about 4 years on the meds, he kind of snapped and went manic. He was then diagnosed with a very serious case of bipolar disorder and the ADD diagnosis was no longer.

[Anonymous]

Anonymous wrote:Do you think that putting a young child, say 5 or 6, on drugs such as Ritalin or Aderol (sp?), can trigger mental illness? I ask b/c I know someone who's child was diagnosed with ADD at 4 or 5 and he was put on Ritalin and then Adderal shortly thereafter. Aren't those really harsh drugs to give such a young child?

Young children are really hard to diagnose. ADHD behavior can be early signs of later mental illness or even signs of traumatic stress. It can be hard when they are young to determine if what you are seeing is 'just' ADHD or if it is the early signs of something else. No I don't think it is the meds that caused later mental illness. It may be that he never had ADHD but that his early symptoms of mental illness mimicked ADHD. Or he may have ADHD and another mental health issue - there is a lot of co-morbidity.

Giving a child meds when they are young can be harsh, yes. Most psych drugs are powerful, not pleasant and have lots of side effects. However it is a risk/ benefit analysis in each case. If the child needs the medication to function academically, to make friends, to be emotionally healthy, then it is worth the risks/side effects associated. That child will be much better off in the long run over the child who was unmedicated and struggled to make friends, who struggled to learn, who struggled to fit into his/her classroom, peer group etc. Medication is not a cure all, many kids still struggle but they struggle less. The long term outcomes show that the more success the child has academically and socially and the better their sense of emotional well-being - the better they will do in the long run. For some kids, medications are needed to increase this success.

[Anonymous]

OP: You belong in a psych ward

[Anonymous]

I posted before but I really wanted to thank the OP again.

[Anonymous]

Anonymous wrote:OP: You belong in a psych ward

Agree. She seems very balanced and thoughtful in her answers. You probably wouldn't want an angry, fly off the handle type working on one.

[Anonymous]

Why can't the patients go out and smoke? I am close to someone with a (pretty well controlled) mental illness, and smoking really takes the edge off the negative side effects of his meds. I understand this is quite common.

[Anonymous]

OP, how do patients end up in a psych ward? I mean, what's the procedure? Do they go to a psychiatrist first who refers them to the hospital? Are many of them committed involuntary?

How long is an average stay?

[Anonymous]

Anonymous wrote:Why can't the patients go out and smoke? I am close to someone with a (pretty well controlled) mental illness, and smoking really takes the edge off the negative side effects of his meds. I understand this is quite common.

Where I work patients who are there voluntarily can go out and smoke. Patients who are admitted involuntarily can not go out to smoke as usually their involuntary status is due to risk to harm self or others. A very high percentage of people with mental illness smoke so yes this causes a lot of problems. We provide patches and gum but some still sneak smokes on the ward.

[Anonymous]

Anonymous wrote:OP, how do patients end up in a psych ward? I mean, what's the procedure? Do they go to a psychiatrist first who refers them to the hospital? Are many of them committed involuntary?

How long is an average stay?

Many come to emergency departments voluntarily (or are brought by family) when they recognize they are in crisis or are too ill to be at home. Others are brought into the emergency department by police. They are assessed in the ER then admitted if need be. Psychiatrists affiliated with the ward can also admit directly. There is also a process for families to get legal help to admit someone who doesn't want to be brought in.

Average stays depend on the type of unit and the purpose of admission. A crisis unit stay is often 3-5 days. A crisis stabilization unit stay is 8-10 days. An assessment unit stay is often 2 weeks or so. A treatment unit stay can run weeks to months and residential units can have admissions lasting months to a year or more.

[Anonymous]

When my son had an extremely violent manic episode (in the grocery store) I had to call an ambulance and a neighbor to collect my other child. He was six at the time and was put on a psych hold in the ER. DH wanted to take him home from the ER but we couldn't because of the hold. We were in the ER for nearly 20 hours before a bed was found for him in a psychiatric hospital. I was furious because Children's had a bed but refused to take us and it wasn't the first time Children's turned us away.

DS was in for 8 days while they adjusted his meds. They wanted to keep him longer but because he had an appointment with his psychiatrist already lined up they let us take him home. Ironically the Dr. that treated him in the hospital joined the practice we go to (our regular therapist left) and we continued the treatment with him.

I have come to hate the word crazy and wish people would stop using it. Mental illness isn't anything to poke fun at. My son will have to deal with this his entire life and I don't want him to have to worry about the stigma that's still associated with mental illness. He's a great kid and my goal is to make sure he has years of therapy under his belt before the turmoil of adolescence. I don't want him to self medicate or refuse to take his meds. Without all this prevention he could be a child who gets out of control and hurts himself or someone else. With all the care he has received his mania is no longer violent but he buzzes around like a bee, can't stop talking, has to touch everything, and he now cycles through it and doesn't crash into depression.

I am sure that someone will recognize who I am because of all the details I provided and I don't care. I want everyone to know what we have gone through and how helpful the psych ward was. I am sure there are more visits in our future and I appreciate everything that has been accomplished.