Tuesday, August 01, 2017

Inpatient Psychiatry: Not All Bad

I'm going to send you over to the Washington Post for an article that was published last week, written by Stanford psychiatry resident Dr. Nathanial Morris:  please check out 'Psych Wards' aren't what you think

Morris makes the point that the inpatient psychiatry units is portrayed something out of a horror show,  when really it is a place of healing.  He writes:

These are places where patients put their lives back together, picking up the pieces torn apart by such illnesses as depression, bipolar disorder and schizophrenia. Caregivers from doctors and nurses, to social workers and psychologists work to heal the sick, to guide patients out of the abyss. Families often reconcile with loved ones. Patients may find hope in one another, opening up in groups, sharing meals, discovering the comfort of shared experiences.

Morris is right. People go in to hospitals in miserable states and they come out better.  They don't, however, necessarily appreciate the care they've received.  As we note in our book, Committed, some people come out feeling terribly traumatized.  If they feel better, they may attribute it to reasons other than the psychiatric treatment they received.  Perhaps they healed from time, or being away from their problems,  or the kindness of a nurse or their fellow patients.   Ah, yes, moments of healing.

Morris points out that part of destigmatizing inpatient care involves acknowledging psychiatry's dark past.  Again, he's right.  What he doesn't say is that psychiatry continues to be dark in many ways related to inpatient care.  Psychiatry is not a money maker -- the resources are not always there for the luxury rooms and pleasant surroundings that might be found perhaps on the orthopedic floor.  And beds are reserved for the sickest of the sick: those who are both ill and dangerous.  We remain the only specialty where pre-authorization for inpatient care demands a life-threatening level of acuity-- if you're not suicidal, you go home.  It means the inpatient units are full very sick people and sometimes there are dangerous, patients may hurt each other or the staff or themselves; it's the sad reality.  And treatment is sometimes dictated by doing what needs to be done in an understaffed environment to keep people safe, even if it means the care is not what is ideal in the long run for the individual patient.  This is not to ruin such a lovely article because Dr. Morris is right (once again)-- psych units are full of tender moments, they are about healing, and they aren't about torture.  Often, they are about pressing the 're-set' button after the power has gone out.

 We're short on beds and negotiating the system is difficult.  It should be easy.  If more people could or would get the care they need, we'd have fewer suicides, less suffering, and fewer people in jails. 

Morris goes on to say: 

Overcoming the stigma against psychiatric units won’t be easy. But I think it’s possible.

Familiarizing the public with psychiatric care is a first step. Stereotypes against psychiatric units endure when these places remain unknown and out of sight. By opening up about the realities of mental-health treatment, providers and patients can address the pervading views of the “psych ward” as a place of torture and imprisonment. This kind of transparency can illuminate psychiatric care’s potential for healing rather than horror.