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

[Anonymous]

I am an adoptive parent; my child has very poor emotional regulation; extreme reactions to anything negative (cutting, vomiting).

My child is in therapy; I am not asking this question as a replacement for that obviously.

Do you have any generic recommendations for what parents can do to support their child's development of emotional regulation?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:We also see a lot of teens from families who have focused too much on making their kids happy/self-esteem, and in doing so kept their kids from feeling and learning to cope healthily with sadness, disappointment, hurt feelings, being in trouble and taking responsibility etc.. When those kids grow into the teenage years, they really struggle to cope with life and teen pressures.

I have an infant. Our goal is to keep her happy. I watch my brother not let his son have his own feelings. My brother in constantly telling him what to do and what to feel. I thought I was doing pretty good at letting her feel her feelings, but I'm not sure. I want her to be able to cope with her feelings, to learn how to deal with sadness, disappointment, etc. in a healthy way. What are these parents doing that leads to this?

As an infant likely you are not so much focused on keeping her happy but on doing the things that make her happy (sleeping, fed, bathed, entertained, attached)etc... the same principle applies as she grows. Your goal should not be to keep her happy. It should be to focus on the things that will ultimately lead to her being happy, healthy and responsible. Those are things like developing confidence, mastery of skills, building strong attachments, competency, coping skills, social skills, self-regulation - emotional regulation and behavioral regulation, reflection and introspection, connecting feelings, thoughts and actions etc.

As she grows let her experience the feelings that she has naturally related to a situation - talk about identifying the feeling and how to cope with it, rather than how to take it away and make her happy. Adversity (not trauma) is good for kids. Life is stressful and age appropriate stress helps them to develop the skills they need to manage it. It is okay to not be good at things, it is okay to fail, it is okay to be sad, mad, frustrated, angry, scared, excited, etc... but there are healthy and appropriate ways to manage these feelings and situations so you learn from them and it leads to growth. Structure, boundaries, limits, expectations, consequences are all good for kids to learn - this is how life works and being unable to understand those connections and when to stop is really important. Developing a strong sense of self is also key - not feeling like you need to be like everyone else or being a chameleon who changes to those around you. Also self-responsibility - no externalizing blame onto others or taking on a victim role, teach them it is okay to make mistakes but you own up to it and take responsibility for it. It is also important they learn to advocate for themselves and have a voice. All of this needs to happen in the context of a family and home (s) where there is a sense of belonging, of being loved and appreciated, of parents who believe in them, of support and attachment.

Not PP but love this answer. Thanks for sharing OP.

[Anonymous]

My 16 year old daughter was ordered by the police to be checked in to the psyc ward after threatening to kill herself . My question is are they allowed to use restraints in the ward. They used hand and feet cuffs and cuffed her to the bed for an houer

[Anonymous]

Anonymous wrote:My 16 year old daughter was ordered by the police to be checked in to the psyc ward after threatening to kill herself . My question is are they allowed to use restraints in the ward. They used hand and feet cuffs and cuffed her to the bed for an houer

If poses any danger to herself or others, based on their assessment of her behavior, she can be restrained and/or isolated until she settles down.

[Anonymous]

Love this thread. I am looking to get a job as a 2nd career new grad RN in psych. I really felt empathy in my psych rotation during clinicals. You have just further confirmed my desire to pursue this specialty as an RN. Thanks OP.

[Anonymous]

Anonymous wrote:My 16 year old daughter was ordered by the police to be checked in to the psyc ward after threatening to kill herself . My question is are they allowed to use restraints in the ward. They used hand and feet cuffs and cuffed her to the bed for an houer

Op here, that is pretty barbaric! Suicidality is a health issue not a criminal issue. We don't use mechanical restraints (cuffs) on our unit, and rarely use any restraint. They are legal but really anti-therapeutic and scary for a lot of kids (and adults) so it goes against the philosophy of the unit. Units should have a least restraint policy - minimum restraint required to maintain safety. What was she doing that they restrained her for? On our unit if she was in the act of harming herself we would physically take the object she was using from her, if she refused to give it up willingly. Usually staff would stay with her and try and talk her down and keep an eye on her. If she was constantly trying to hurt herself and grabbing at things and we couldn't deescalate her or feel we could keep her safe even with 1:1 support then we would go to our seclusion room which is a room with nothing in it - reducing the risk of harm. If she was really agitated we would offer her medication to help her calm down and regain a sense of control and stop harming herself. If she continued to harm herself in the seclusion room and refused the medication then we might do a chemical restraint and give her an injection against her will - however to do that there truly has to be imminent harm (actively trying to hurt self or others and all other attempts have failed). To give a chemical restraint, there has to be a physical restraint too. Out of 350 acute crisis admissions a year - we get to this point maybe a dozen times a year. We would then continue 1:1 until the meds kicked in and she calmed down.

Every unit has its own philosophy, policies and practices. You may want to look at your options and see if there is a unit with a more therapeutic, trauma-informed philosophy.

[Anonymous]

Anonymous wrote:

Anonymous wrote:My 16 year old daughter was ordered by the police to be checked in to the psyc ward after threatening to kill herself . My question is are they allowed to use restraints in the ward. They used hand and feet cuffs and cuffed her to the bed for an houer

Op here, that is pretty barbaric! Suicidality is a health issue not a criminal issue. We don't use mechanical restraints (cuffs) on our unit, and rarely use any restraint. They are legal but really anti-therapeutic and scary for a lot of kids (and adults) so it goes against the philosophy of the unit. Units should have a least restraint policy - minimum restraint required to maintain safety. What was she doing that they restrained her for? On our unit if she was in the act of harming herself we would physically take the object she was using from her, if she refused to give it up willingly. Usually staff would stay with her and try and talk her down and keep an eye on her. If she was constantly trying to hurt herself and grabbing at things and we couldn't deescalate her or feel we could keep her safe even with 1:1 support then we would go to our seclusion room which is a room with nothing in it - reducing the risk of harm. If she was really agitated we would offer her medication to help her calm down and regain a sense of control and stop harming herself. If she continued to harm herself in the seclusion room and refused the medication then we might do a chemical restraint and give her an injection against her will - however to do that there truly has to be imminent harm (actively trying to hurt self or others and all other attempts have failed). To give a chemical restraint, there has to be a physical restraint too. Out of 350 acute crisis admissions a year - we get to this point maybe a dozen times a year. We would then continue 1:1 until the meds kicked in and she calmed down.

Every unit has its own philosophy, policies and practices. You may want to look at your options and see if there is a unit with a more therapeutic, trauma-informed philosophy.

OP, as a parent of a child who has spent time in a psych ward, I want to thank you for your compassion and caring; nurses and doctors like you enabled my child's experience to be a healing one and I feel immense gratitude for that.

[Anonymous]

Has any staff members been killed or viciously maimed by a patient?

[Anonymous]

OP, thanks for what you do. There are so many under medicated and/or overmedicated people in this area, it seems.

I wish more people would admit they need help, instead of trying to label/deflect to others. This is anonymous, so I am hoping the proper person reads this.

[Anonymous]

I'm trying to write a book about a 18-year-old young lady who wants to adopt her older sister who lives in a psych ward before the holocaust in the 1940s. Would that be possible for her to adopt? Or is it entirely the hospital's responsibility?

[Anonymous]

What percentage are under 24 for mental illness? It seems I l know more kids than ever in the 20-24 year age range suffering from depression, bipolar,etc.....it seems epidemic.

[Anonymous]

14:50 - I see so much of that! Thank you for posting this.

Do you find that the most nosy and judgmental people are the ones that need the most help themselves? Do they deflect as much as it seems (or perhaps more)?

Why don't more people get the help they so desperately need? Do they think it is a stigma? Are they afraid people will find out?

Do you worry about so many who seem concerned with "public persona" only?

Or do you not see this side of people in your profession?

[Anonymous]

Anonymous wrote:Has any staff members been killed or viciously maimed by a patient?

Op here! Just noticed this thread was bumped up again!

No, I haven't ever seen anyone (or heard of anyone personally) killed or maimed. Generally the onus is on staff to keep themselves safe. When a unit has sufficient staffing, good teamwork, skilled staff with strong assessment and deescalation skills, and unit policies and procedures that promote respect and safety, it is much easier to keep yourself safe. Regardless of the unit, I consider my own safety to be my responsibility and I make decisions based on that.

[Anonymous]

Anonymous wrote:What percentage are under 24 for mental illness? It seems I l know more kids than ever in the 20-24 year age range suffering from depression, bipolar,etc.....it seems epidemic.

Op here - it does seem epidemic. College mental health services are absolutely overwhelmed by the demand for services and can't meet student needs. I work part time in academia and I see it first hand. I pretty much have a steady stream of students through my office who are struggling with their mental health. In my opinion a few reasons for this are...

- most mental illness first present between the ages of 15 and 24. About 75% of adults with mental illnesses report a first occurrence during that age range. With more awareness and on-campus campaigns, it is likely that more students are getting support during these first or early presentations of their illnesses.

-there are two major transitions in the 17-24 age range that are incredibly stressful. The first is the transition to college. For many students this is the first time in a brand new environment away from home supports, first time living on their own, first time with the more rigid expectations that come with post-secondary academics. For some students they get lost in the sea of college, others struggle with the first B or C or D they have ever had, others struggle with too much alcohol/drugs/time online/insufficient sleep due to making their own life decisions for the first time. For kids who may have had more mild illnesses (mild depression or mild anxiety) or those who are vulnerable genetically to mental illness, the coping strategies that they used before are insufficient in this higher stress environment and they illness worsens or rears its head. The second major transition is out of college and into the workforce and there is both the stress of finding a job but also the loss of identity of being a student and all that comes with it that again can trigger or worsen issues.

- a lot of kids who grow up with dysfunction, conflict, abuse or otherwise difficult life circumstances often don't begin to emotionally or mentally deal with these issues until they are in their early twenties (or later). When they are still living the dysfunction, they have to keep it together to survive and get through it so they do. They take life one day at a time and often focus on graduating high school and moving away from home as their goal - but when they achieve that and are in a safe, stable environment where they no longer have to deal with the dysfunction, they fall apart. All the pent up stress and emotion that wasn't safe to express while at home comes out and with it you see depression and other mental health issues.

-kids today do not have to deal with as much adversity overall as kids did in the past and therefore aren't as resilient. I don't mean on an individual basis but just life as we know it has far more conveniences and luxuries than ever before, it gets easier for every generation. While this progress is good, it means there are far less opportunities built into daily living for kids to experience adversity and build resilience. They just don't have to develop, practice and test their coping with hardship skills very often. So when kids grow up and start to take on the adult responsibilities and even meet college expectations - much of this is much harder than anything they have experienced before and they really struggle with managing the expectations.

I hope though that part of the reason we are seeing more is that there is less stigma and more awareness and that changes are being made to better support students. There are more transition programs and self-care campaigns being worked into first year by colleges. There are more options for services and supports (still inadequate) but students see flyers and hear speakers talking about mental health.

[Anonymous]

Anonymous wrote:

Anonymous wrote:What percentage are under 24 for mental illness? It seems I l know more kids than ever in the 20-24 year age range suffering from depression, bipolar,etc.....it seems epidemic.

Op here - it does seem epidemic. College mental health services are absolutely overwhelmed by the demand for services and can't meet student needs. I work part time in academia and I see it first hand. I pretty much have a steady stream of students through my office who are struggling with their mental health. In my opinion a few reasons for this are...

- most mental illness first present between the ages of 15 and 24. About 75% of adults with mental illnesses report a first occurrence during that age range. With more awareness and on-campus campaigns, it is likely that more students are getting support during these first or early presentations of their illnesses.

-there are two major transitions in the 17-24 age range that are incredibly stressful. The first is the transition to college. For many students this is the first time in a brand new environment away from home supports, first time living on their own, first time with the more rigid expectations that come with post-secondary academics. For some students they get lost in the sea of college, others struggle with the first B or C or D they have ever had, others struggle with too much alcohol/drugs/time online/insufficient sleep due to making their own life decisions for the first time. For kids who may have had more mild illnesses (mild depression or mild anxiety) or those who are vulnerable genetically to mental illness, the coping strategies that they used before are insufficient in this higher stress environment and they illness worsens or rears its head. The second major transition is out of college and into the workforce and there is both the stress of finding a job but also the loss of identity of being a student and all that comes with it that again can trigger or worsen issues.

- a lot of kids who grow up with dysfunction, conflict, abuse or otherwise difficult life circumstances often don't begin to emotionally or mentally deal with these issues until they are in their early twenties (or later). When they are still living the dysfunction, they have to keep it together to survive and get through it so they do. They take life one day at a time and often focus on graduating high school and moving away from home as their goal - but when they achieve that and are in a safe, stable environment where they no longer have to deal with the dysfunction, they fall apart. All the pent up stress and emotion that wasn't safe to express while at home comes out and with it you see depression and other mental health issues.

-kids today do not have to deal with as much adversity overall as kids did in the past and therefore aren't as resilient. I don't mean on an individual basis but just life as we know it has far more conveniences and luxuries than ever before, it gets easier for every generation. While this progress is good, it means there are far less opportunities built into daily living for kids to experience adversity and build resilience. They just don't have to develop, practice and test their coping with hardship skills very often. So when kids grow up and start to take on the adult responsibilities and even meet college expectations - much of this is much harder than anything they have experienced before and they really struggle with managing the expectations.

I hope though that part of the reason we are seeing more is that there is less stigma and more awareness and that changes are being made to better support students. There are more transition programs and self-care campaigns being worked into first year by colleges. There are more options for services and supports (still inadequate) but students see flyers and hear speakers talking about mental health.

Could it also be that more people are going to college now? So those who had mental problems floundered in high school and then didn't go onto college.