IamA worker at a state Psychiatric Center. I have seen too much, AMAA!

Whats the best/most convincing, alien/conspiracy story you have heard?

Haha, good question! It's really funny that in all my years doing what I do, I actually haven't heard many alien stories. Almost 80% of the wacky stories I hear are government related.

The one that I'd say was the best or most convincing was this one guy who came into CPEP at a different hospital than the one I'm working in now. Just before being admitted, I spoke with him about why he was there. He said he needed someone to take the chip out of his chest.

I immediately went into, "Here we go again" mode, but before I could even begin to try to make him understand that there was nothing like that inside of him, he lifted up his shirt, pressed into the skin on the sides of a spot on his breast, and there it was. I swear on my life, to this day, I have no idea what it was.

It was black, small as a crumb from a cake, and it was hard. There was no wound or clear point of entry, and it was DEEP. Like multiple layers of skin deep.

He pushed at it, and the thing seemed to have a marking on it, but it was so small I couldn't tell. He said he woke up that very morning with it in his chest and he discovered it when he felt a warmth there. He was a bank teller (verified) and lived a perfectly normal life. No previous psych history (verified) or family history (verified).

Everything about this guy, including his demeanor, was so fucking normal. There was nothing observably odd about him, except his reasoning for coming to a hospital.

He was admitted, and discharged over night. And I never saw or heard of him again.

Weird shit.

Have many people come in convinced the government is listening to their every word? If so, how have they taken being right?

The numbers are astronomical. Since Mr. Snowden's leak, we hear sooooooo many I-told-ya-so's.

Haha, that's sort of nice to hear, in a way. Has it had any calming effect or whatever on any of the ones who said it? Like, suddenly, they know what they were saying is taken seriously now and don't need to fight about it?

I haven't noticed, to be honest.

I guess it's either that they've become lighthearted about it, or they've become even more angry about it.

And rightly so! Are they allowed to write letters of complaint if they wish, or is their contact with the outside world limited?

No, we encourage patients' contact with the outside world. Most of them think we just throw out their letters they right, but just like how the USPS sends all of Santa's letters out, we send all of the patients out too.

How do you respond to that without increasing their paranoia, etc.?

You have to walk a very fine conversational line. Over time you learn a very fine balance in conversations with patients.

Trust me, it's not easy.

Obvious question, but, have you ever seen people who were in your center after they were cured or after the recovered ? If so, were they grateful ? Did they found job or stuff like that ? I don't know much, but I wonder what happened to these people if they recover from their illness.

Thanks for the AMA and the risk you take by doing this.

I don't know how I missed this question, and it's a damn good one.

Unfortunately, I have to tell you that mental illness is very much more often than not a revolving door kind of thing.

I know a ton of these people by name and face because they come in and out of here like clockwork. It's to the point where oftentimes I will say, "See you around." rather than, "Goodbye!" because I not only know they'll be back, but can often predict when and why.

Sure, sometimes there are cases where an individual gets the help they need, get set on meds that help them, and go through programs and are great success stories. Those are few and far between.

Edit: To expand on the positive part, the ones who get help but still keep coming back do often understand the extent to which they've been helped. They are very often grateful and I get thanks and offers of gifts constantly. Obviously, I can't accept the gifts, but it's really cute when someone goes to the cafeteria and buys you a coffee because you got them a meeting with a team leader to discuss a problem they've been having but felt ignored on.

My eldest son is mentally ill. I tell people that there is no such thing as a cure; there is health management. We try to manage mental illness and give the safest, highest quality life possible for him and those around him.

Most people find this very hard to understand. Pop culture and tv dramas have a lot to blame. They would have people believe that there is a silver bullet or with the correct diagnosis there's simple and easy cure. One linchpin event in the person's life that caused the illness and it's a simple matter of undoing the damage. That of course is nonsense but that's what people believe. (There might be some severe illnesses that revolve around a single event, but that seems to be very uncommon among my son's peers.)

Yeah, sometimes an issue can be solved with talk-therapy and even assisted with drugs. Sometimes someone just needs help getting over something or through a dramatic event.

Usually though, it's cases like your son. I wish you and him well. <3

Damn this is my biggest fear. Thank you for the work you do, helping to look after people in some of their most vulnerable times.

Glad to do it. Doing this AMA has been a great opportunity to re-gain some perspective myself.

a team leader

What does this 'team leader' refer to exactly, in a psychiatric hospital?

A team leader is basically an individual who heads up a group of staff that provide clinical or rehab services to patients.

What's your worst memory working in a psychiatric hospital?

I worked at a hospital in eastern Long Island not long ago, and grew fond of one patient in particular.

Every day, he would come see me in my office in the morning. Every day, he'd think he was the slickest little bugger ever, and he'd "sneak up" on me to scare me. "BOO!" he'd yell, and every time, I'd have already heard him coming because he walks like a lumberjack lol

He'd always small talk me for a while, thinking he was lowering my defenses, and then he'd do what he always did, ask me for $.50 cents. I never could though. Against policy.

Anyway, one day, and this was normal, I heard violent banging out in the hall. A patient was slamming their head against the wall, moaning and crying.

I usually ignored this stuff and let the response teams deal with it, but this time I recognized the moans. It was him. There was blood all over the wall, his face, and the floor. The one doctor with him (he was supposed to have two) was trying to stop him, but he's a healthy, strong guy.

He wound up in the ER, and I've since seen him, but he's absolutely not the same. He did a lot of damage to himself that day. And it was all over a hearing test he didn't want to take.

Why didn't he want to take it? Because the doctor hadn't yet let him come try to sneak up on me. He said, "I need to, he's my friend, he'll miss me."

When I heard he'd said that, I cried. I hate this job sometimes.

I work in a CILA and I absolutely hate it when administrators come in and decide some little things need to be "tweaked" in some of our individual's daily routines. Something that seems silly and a waste of time for them actually means the difference between getting them on the bus to day program or secluding them in their own room and shutting off other residents because this person throws microwaves when they have melt downs over a change routine.

I'm glad you're doing this AMA. :D

Edited:I work overnights and I lose the ability to spell before bedtime :P

One of my favorite patients right now likes to stop and look at the paintings for about 5 minutes in the hallway on the way to program.

The hallway is right behind my office, so he always invites me to come look with him. He understands that I can't always come, but I try my best to join him. He really does always have some insightful observations about them, it's great.

Anyway, yesterday or the day before, I forget, his caretaker kept pulling at his arm, trying to get him to program without letting him look. I heard him yelling since he's right outside, and I had to explain his routine. She couldn't give less of a shit, but obliged anyway.

I've already had her removed from his care. Can't stand that shit.

Where on Long Island? I'm curious because i live on eastern Long Island.

Being careful with this answer: Western Suffolk.

What is the funniest thing you have seen one of the patients do?

lol oh man, I don't know if it's the funniest, but I've got this one guy right now who thinks he's a different ex-president every day. But it doesn't end there. The ex-president he chooses, depending on that president's first letter of their first name, will take on the attributes of a musician with the same letter in their first name.

He walks around the cafeteria area putting on what amount to performances. It's amazing.

The best was when he was Lincoln. It became Abraham "ABBA" Lincoln. Best rendition of "Dancing Queen" by a president I've ever seen.

Thank you so much for doing this. I've learned, laughed and cried.

You're very welcome. So have I. :)

oh my god this sounds amazing....

It's a sight to see, but I wouldn't recommend hearing it. Dude's as tone-deaf as I've ever heard.

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Actually, it'd be safe to say that ~20% of the people I interview/screen are individuals who have no reason to be here.

We hear a lot of sob stories like, "They sayin' I'm crazy but I'm just tired man!" and they really do need help, but a lot more often than you'd think, someone comes in who was just in the wrong place at the wrong time, often saying the wrong things and not thinking.

Wow. How long does it take for people to figure out they don't need to be there and send them on their way/to more appropriate treatment?

Usually in a matter of hours. I'd venture to guess the average case like this winds up being figured out within 2 hours.

Sometimes though, these people who are wrong-place/wrong-time types, just act like dumbasses. They start walking around, yelling at doctors, getting all bent out of shape, etc. And while I get why you'd be upset if you weren't mentally ill but were placed in a psychiatric unit at some hospital with people who are really ill, you're not helping your case by acting crazy.

That's reassuring. How often do you get people who are actually intoxicated/high/having a psychical issue that appear to be mentally unhinged but aren't? Or are those usually sorted out earlier in the process?

Always sorted out earlier.

Could you elaborate? After badly frying my brain on drugs and a 72 hr waiting period without improvement, I was submitted to a psych ward. I was discharged in ten days once I stopped exhibiting signs of psychosis. There were another 4 to 5 patients who seemed to be there for primarily drug related reasons, although I can only speculate based on what they told me. Are you dealing with people in more long term care facilities? Otherwise, psych wards seem like a bit of a dumping ground for ODs and drug related psychosis, but I would love your insight.

No, I definitely see a lot of people come in that are just in the midst of a bender of some sort. Those people will usually just stay on medical units though.

The ones that more often come across our area are those who the doctors feel have underlying mental health problems that are either leading to their substance abuse, or that are coming from their subtance abuse.

Do those people also tend to come back again to the hospital after the are discharged?

Usually no, they don't. 99% of the time, from what I've seen, if you don't belong in a psychiatric hospital, you won't wind up in one, and if you do wind up in one, you won't come back.

Only a crazy person would voluntarily commit himself to a psych ward for no reason.

Well, "no reason" is subjective. Often with these types of situations, I'll see someone come in who doesn't belong, but checked themselves in because they misunderstand the criteria for being in such a place.

Some people really think psych wards are allowed to be treated like little vacations away from their problems. And boy are they wrong.

What is the most fucked up thing you have seen in your time on the job?

Hmm, number one most fucked up thing?

I'd say it was "The Bite Incident" -- not a pretty story.

Not all too long ago, we had a very flamboyant and funny patient, I'll call him Jay. He liked to dress like a pimp, always in purple. Always walked with a certain swagger, but in a very feminine way. He was almost adorable if you could forget for a moment that he was there because he raped a young boy. Jay was locked up as a CPL (criminal protection law) because he committed crimes but is mentally ill. Part of Jay's requirements in psychiatric detention is to attend group sessions.

Over the course of these group sessions, Jay built up a bit of a beef but also a homosexual fascination with another patient, Barry.

One day, Jay was on one of his rambling tirades about the government when Barry shouted, "Shut the fuck up, Jay! No one wants to hear your faggot bullshit!" -- to which, Jay replied, "Fuck you Barry, you just mad 'cause you got a little dick, bitch."

Barry then said, in a very sarcastically-seductive tone, "Yeah faggot? Come suck my "little dick" then." and proceeded to pull out his penis.

At this point, the psych leading the group began to seek assistance. Before he could, little 'ol Jay was across the circle of patients, on his knees, fellating Mr. Barry.

Fairly quickly, the response team arrived to do whatever it is they planned to do. In the heat of the moment, and probably out of surprise or fear, Jay panicked, clenched down, and bit off Mr. Barry's penis.

Jay got in a lot of trouble that day.

Barry I haven't seen since.

I'll call him Jay

ಠ_ಠ 

Oh, heya Jay! Behaving?

Instantly thought of this for some reason.

I'm afraid to click that at work lol

That sounds like the sort of thing that would have made it into the media.

Pretty sure it didn't. I remember working closely with the attorney who was assigned to defend "Jay" and asking the same thing.

There are mountains of incidents like this that don't get put into a newspaper.

I'm pretty sure its because patient confidentiality laws (like HIPAA) have extra-strict requirements regarding patients in mental facilities.

HIPAA is a BIIIIIIIG big deal here.

Hey there, I'm a relatively new nurse working in an inpatient psychiatric unit. From time to time I get a little burned out from repeat patients who are unwilling to help themselves or work toward recovery for the sake of attention seeking (a lot of borderline patients with suicidal gestures and no intent, for example). What do you find helps keep you from becoming jaded?

It's funny, I sometimes find myself relying on the repeaters for my own sanity because you form a bond with them. You get so used to seeing the same people come in and out, you can't help but to form relationships with them to a degree.

But you're right. A lot of it is attention-seeking behavior, and it'll never stop for some of them.

The only thing that keeps me from becoming jaded, every single day, are those "one out of ten" types. The ones that come in, need us, and leave having been helped, and are never to be seen again.

Yeah, it ony happens every so often, but I feel like it's really helpful to think about them every day because they exist. We did help them. They are okay. They may not be the usual case, but it's one of those, "If you can help just one person, you've made a difference." things.

Keep your head up. It's people at the bottom of the totem pole with good hearts that we need more than anything!

I was a 1 out of 10 type a loooong time ago!

Good for you man. Stay healthy!

As a person with Borderline who self-harms, it's seriously distressing to hear mental health professionals peg us as "attention seeking" and say that "it'll never stop." :/ It's a painful condition (that with good therapy can be aided), and a lot of that behavior comes from not having learned any good outlets or coping skills. Saying that it's attention seeking is just adding to the stigma, the sense of isolation, and the lack of validation that Borderline people go through every moment of every day.

Aside from this, awesome thread.

Oh, please don't misunderstand. I don't think those with BPD are attention-seekers in any way whatsoever. If I speak negatively about attention-seekers that come through these places, it's those who truly have no mental illness to speak of.

I know where you're coming from about BPD being something that is kind of brushed aside sometimes, but I see it taken very seriously more often than not.

Why didn't you believe Bruce Willis when he said he had travelled back in time to prevent an apocalyptic bio-weapon from wiping out the majority of the world population?

All jokes aside, I did have someone come in once who recited the entire plot to Twelve Monkeys to me.

When I told her that I'd seen the movie, she just smirked and said, "Yeeeeah? What movie?"

She's still a patient at that hospital. That was 2 years ago.

Or Sarah Connor when she tried to warn everybody about the rise of the machines?

Yeah, OP should have never licked her face.

lol you just made me think of a patient who reminded me of that character. Except she did the licking. Strange bird she was.

Hello, once you're cleared I have a question for you. How would you describe your average patient? Is there a common denominator of poor psychiatric health?

I'll be detailed. The average patient is between the ages of 25 and 40, black or hispanic, average health, speaks fairly well but not well enough that you can't tell right off the bat that there's something wrong with them.

I'd say if I were forced to choose a common denominator of poor psychatric health, it'd be the individual's upbringing/parenting having been very poor or non-existant.

Would you say that has more to do with the location of your facility (in an urban area with higher AA and Hispanic populations)?

No. I work at about 12 different facilities in all different types of demographics. This is generally the case in all of them.

Do you feel that the excessive borderline abusive nature of the discipline both cultures tend to have are a major contributing factor?

Sorry, that question was kind of hard to follow. Do you mean do I think the abuse patients are sometimes subjected to in hospitals is a contributing factor to their issues?

If that's the question, then sort of, but not too much.

I've definitely seen plenty of cases where a patient develops a deep hatred for their handlers and doctors because they have justified issues with their behavior or abuse.

More often than not though, patients will develop long-lasting issues with these places because of one bad apple ruining the bunch kind of stuff. They'll have one bad experience with one dumb doctor or caretaker, and suddenly they'll think the whole system is out to get them. It really sucks.

Sorry let me clarify. Man Hispanic and African american families follow the corporal punishment method. Do you feel this type of punishment growing up contributes to many of your clients issues.

Oh I see what you're saying. I don't see it as an ethnic thing as many, many caucasian families treat their children this way and I see the results of it all the time.

Either way, ethnic or not, it's definitely a contributing factor. Any time you subject a human being to conditions and behaviors that cause fear, you're going to get some sort of mental effect.

I often speak to families and describe things like this in comparison to muscles in our bodies. We strain muscles and cause little micro-tears in them all the time, and we must repair them. And we do the same thing with a child's mind when he/she is abused in such a way.

Too often though, the repair to these "micro-tears" never comes, and a mind winds up breaking in some way.

How often to individuals/clients at your facility develop romantic relationships between each other? How are those handled by staff? Are they common place?

Great question! More often than you'd think! Sometimes it's really really cute lol

I actually just had a patient who was successfully moved to another group home, and the plan was to have his girlfriend go with him. For some reason, they wouldn't sign off on her going too, so he came to us to help.

We eventually got them back together, and it was a big win even though it's small potatoes. They're a couple of wacky dorks, and I loved seeing them together. I'll miss 'em.

Edit: Sorry, forgot to answer the how it's handled by staff part. Um, in short? Carefully. In situations like a developmentally disabled center, you can't really stop patients from getting the feels for each other. Sometimes it can become inappropriate though.

I recently saw a patient need to be restrained and taken away when he went up to a female patient who did not share his affections, and kept hugging her. The caretakers tried to stop him verbally at first, but when he hugged her a fourth time but with his hand on her breast, it got physical.

Really unfortunate because he probably didn't mean to hurt her, physically or emotionally, but they just don't understand boundaries like we do.

What forms of mental withering have you witnessed? I mean, did you ever witness a day by day breakdown of another person?

Ugh, constantly. Not all patients can be cared for properly. We see this all the time in medical. It's 10x worse in psych. There simply are not the resources to properly treat everyone that comes in, and there's just so many of them.

I see withering all the time. Someone will come in who simply had a "bad day" or a nervous breakdown. They'll check themselves in, or maybe a family member will bring them. They'll come in thinking, "This is gonna be great. I'll get the help I need and maybe some meds to help out, and I'll go home."

Then a matter of days later, they're begging to be heard by a Judge, sobbing in the halls because they're finding themselves basically imprisoned on the grounds that two psychiatrists found a need for them to be evaluated further. They just didn't expect it.

Days, weeks, months go by and they lose hope of leaving. The hospital becomes their life. They become institutionalized. I'll watch as they go from some guy with a bit of an anxiety issue who snapped and had a nervous breakdown one day, to a full blown lunatic who runs around screaming and threatening people for no good reason.

It's fucking heart-wrenching.

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Not too many differences I'd imagine.

I'm sorry you went through all that. I wish I could say I don't see that happen often, but I do.

It's why we need more hearts with the minds that work here. They often don't go hand-in-hand.

I asked because my grandfather has very severe alcohol induced dementia. It's so strange what remains when he can no longer remember my mother, let alone his grandsons. But the little things, how he smokes, how he paces while doing it. They are the exact same. My uncle Micah has those same characteristics and drank heavily, almost as a cycle of life repeating. Thank you for caring.

I see quite a bit of "it runs in the family" issues. More often than you'd think, I'll be dealing with a family member of a patient, and not too long after wind up seeing them admitted themselves. You can almost always see it coming.

Wow, this blows my mind. How often does it happen that someone who checks themselves in voluntarily is then kept for other reasons? What is the percentage of patients there voluntarily as opposed to committed by a court or some other means?

How often does it happen that someone who checks themselves in voluntarily is then kept for other reasons?

Maybe 30/40% of the time. People will often come in voluntarily to get away from something that's been setting them off or causing stress, and they will be observed to have an underlying mental illness that needs to be treated or assisted with.

What is the percentage of patients there voluntarily as opposed to committed by a court or some other means?

It's different for every hospital/area, but on average from my experience, I'd say 30% come in voluntarily. Those who wind up staying and are still voluntary though, that percentage is maybe 10.

Have you ever been in a situation at your job where you needed to get the police involved? If so, please explain.

Too often, actually.

I deal with the police on a roughly bi-weekly basis it seems.

Most often it's because a patient has become such a danger to himself or others that our response teams on call can no longer rely on their usual methods to bring the situation to a calm resolution.

Most recent example was yesterday. A family member of a patient said some horrible things to his brother, and the patient completely flew off the handle in the hallway they were in. He removed a fire extinguisher from the case on the wall, and proceeded to bash it into the wall, hit the family member in the shoulder, and then corner himself, threatening to kill anyone who came near him.

There's just some things that an ACT team can't do.

What is the most disturbing and/or frightening thing a patient has ever said to you?

I once (and only once) had my girlfriend meet me after work in the parking lot.

I had one patient who was constantly empty-threatening me because we couldn't get him out of lock-up. Sorry dude, you tried to cut your daughter's lungs out with an exacto-knife. You're not going home.

Anyway, on the day my gf came after work, he was near the swings next to the lot. I noticed him, but didn't speak to him. We left and went about our night.

The next day, he was at our office, and he walked straight in, right to me, leaned down and said, "Ignore me again, [name], and I'll make sure I know exactly what her tears taste like." and walked out.

My relationship with that patient ended that day. Bad move on his part. Still, it gave me chills.

What are the consequences for such threats?

There's not really a standard manner of dealing with things like that. Sometimes, depending on the threat and the person reporting it, they'll have things taken away from them, or if it's really out of hand, charges can be pended against them.

In this case in particular, I had heard he was barred from our building, and furlough priviledges were taken away, but I'm not sure.

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No, I really try not to take things personally. You just can't.

99% of the time, you get threatened because you're in the wrong place at the wrong time. They'd threaten the Easter Bunny if he were there. It's not personal.

Sometimes, like this story, yeah it was personal, but I still have to say, "He's sick. He's not in his right mind." and let it go.

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Honestly, no. I've learned over the years that it takes way too much emotional energy to allow myself to be offended by misconceptions.

And really, if we're honest about it, the media often gets it right when it comes to how things are in these places. I go toe-to-toe with doctors all the time that clearly do not have patients' best interests at heart. Sure, they're outnumbered by those who do, but bad apples, you know?

How do your experiences compare to those of asylums in the '50s and '60s?

They're probably less frequent, but they're sometimes just as gruesome and depressing.

Most people in the general public think that we've cleaned up our psychiatric hospitals very nicely, especially after incidents like Willowbrook.

But honestly, check yourself into a place like Jamaica Hospital Center for a weekend. Do it on a Friday. See if you can get out, in perfect mental health, in less than a week. Chances are, you won't. And while you're there, take note of the horrifying conditions these people are forced to live in.

Patients are understood so much better today than they used to be, but I'll tell you flat out, they don't get treated much better. They're treated like scum, or freaks. It's disgusting.

Has anyone ever escaped or come close to escaping? What was that like?

Ever? Please! Try daily!

We get incident reports of all the different stuff that happens in these places, and a good ~30% of them are missing persons.

Most recently we had a patient go missing after they found out that a female patient he was trying to avoid was being moved to his group home. He used to have sexual relations with her, but had since broken it off and was trying to distance himself from her. When he heard the news of her moving to his group home, he ran off.

We've since found him, and everything is fine, but the female patient was really worried. :)

Wow, I had no idea it was that prevalent. Thanks for taking the time to answer all these questions. This is a great AMA!

Absolutely glad I could clear my workload today and do it. This has been very theraputic for me lol

Do you have any issues with patients' family members?

Boy do I.

I get calls every single day from all manner of family members. Some of them just want someone to talk to. They're going through a hard time. They're so used to dealing with doctors who are very cold and flat.

Sometimes though, they like to blame me and the people I work with for their family member's issues. They often don't understand the limited resources we work with. And I never blame them.

I have never once raised my voice back at a family member. They're going through hell too, and they're sane enough to understand it all.

This is a genuine question.

Do some of these patients turn to religion?

Have they been admitted for something related to religion?

After all you have seen, what are your beliefs?

Do you mean turn to religion after being admitted? Yeah, lots of times. Most often it's when they befriend someone with a good connection to their religion and they find it comforting to get involved in it too.

I've seen lots of admissions come across my desk with details of how the patient thinks they're Jesus, or some other religious character.

I once had someone come in thinking their husband was Jesus, and that she needed to send him "back to Hell" by bathing him in a fountain in Brooklyn somewhere. He nearly drowned. Was not Jesus.

My beliefs? I'm agnostic, but not annoying about it. I love talking about patients' religions and will more often than not encourage them to use their beliefs to help get through their troubles. Sometimes it's not healthy for them because they're using the religious beliefs as an excuse to do bad things.

I really appreciate the answer.

I was curious of how a psychiatric patient, one who causes harm, might justify his actions with. Who he holds responsible.

You usually don't see or hear a lot of justifying. Reason isn't really one of the common things going on around here.

Would you say that Psychiatric Centers are depicted accurately in film?

It really depends on what film. Obviously stuff is going to be exaggerated in movies, but if you're talking about stuff like "Awakenings" then yeah, it's pretty accurate.

There's a lot of silliness here, but also a lot of good hearts and fun times. It doesn't balance much with the horrible shit that happens, but it's there if you look for it.

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Honestly, no. I chose this job because it came with incredible benefits and a pension. It wasn't until a few months into it that I realized how rewarding of a job it would be, and also, how scary.

I definitely have become desensitized to a degree, but only to a degree. I have a good friend who works in an ICU, and she says the same thing. You get used to certain things, and develop a "thick skin" of sorts, but you're never numb to what goes on completely.

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It affects me outside of work, yeah, but I think in many more positive ways than negative. Remember, it all depends on how you allow it to affect you.

Have you or anyone you know who works with you ever bent or broken the rules to help a patient?

All the time.

How often do you have to restrain people? Also what happens if someone bites you, throws shit/piss/blood on you?

Someone gets restrained in some manner of speaking about 5-10 times a day. Definitely goes up depending on the facility.

With regard to bites/scratches, etc. we get tested and immunized for different things constantly. We have standard procedures for TB and things like that.

Obviously any substance you're exposed to is a concern, especially blood and feces, but it happens. I've had patients throw shit at me, try to piss on me, etc.

I've even had one patient who was known to be HIV+ slash himself with a piece of glass from a broken picture frame, and come running at me in an attempt to get his blood on me. He didn't make it 3 steps before he was "handled".

Thank you for doing this AMA! My question is, do you find most patients that come into the psychiatric center are mostly helped with proper medication? Or do you feel more patients that come in are helped with counseling? When patients are admitted are they put on meds right away?

Definitely check out my answer to /u/funkarama's question.

To add to it, I will say that a lot of doctors still just throw drugs at these people and push them out the door. It's just what they're used to have been doing all these years and it's easier than actually treating the problems.

Sometimes, yeah, drugs are the solution. Sometimes you can't counsel someone out of being bipolar or borderline personality.

But like I said in my answer to that other question, it's becoming more and more the case that patients will be treated more long-term and in multiple phases. It's great.

i have GAD and have had episodes. drugs and alcohol helped get me there. my anxiety worsened at the very end of college and got pretty bad (see: manic, episodes of psychosis) at 25ish. i blew up. it was stress. i felt like i'd never feel normal again. my head buzzed all the time and i was afraid to leave the house. one night after a particularly bad binge and synthetic-weed related freakout, i checked myself in.

it helped a shit ton. some form of therapy should be a requirement for everyone. it'd be a much nicer place out there if people went for mental health checkups as often as they went for physical health ones. i did a short stint on zoloft and xanax and then tapered down to zero. i still smoke cannabis, but am free from prescription drugs for over two years :)

my gf is going to counseling now and is thrilled so far. its really important. sure, white people problems or whatever... but really, mental health issues are incredibly common, and often overlooked. sometimes all we need is a paid professional to bitch at for an hour or two a few times a week, to start feeling better.

props OP - the world needs more caring mental health professionals. people don't realize how awful mild mental illnesses can be, nor are they aware of how easy it often is to treat them!

i post in all these threads, and i tell everyone i can about my little history with being a mental patient. i consider mental health here in the USA to be a national fucking emergency. i encourage EVERYONE to not be afraid or embarrassed about seeking help for anxiety or depression, no matter how mild or 'normal' you think you are. if you've ever considered it, it is interfering with your life and you don't have to live that way!!

my GP drs. (whom i liked very much) basically threw drugs at me and handed me some dittos. only certified mental health pros will understand. if you don't like the first one you try, go to another. if you're afraid you're going to do damage, check yourself in.

not everyone in MH is an angel, but people like OP here can and will help you, and they do care.

Put a huge smile on my face reading this.

Thank you. :)

Thank you for your response.

Absolutely. :)

Don't think I have a question that hasn't already been asked but would like to say thank you for doing this and your answers are really fantastic.

Thanks a bunch! It's hard to know what to/not to say. I hope I'm giving enough detail without being too vague.

I work as an EMT for an ambulance company in California and I've transported hundreds of patients with psychiatric problems. Is there any way patients can dispute being on a 5150 (involuntary 72 hour hold)? I understand its physician ordered, I've always wondered if a patient can take it to court.

Not only can they take it to court, but the department I work in is the one that helps them do it.

Every patient has the right to appear in front of a Judge and make their case, with an attorney present (free in my state).

What would you recommend to someone who graduated with a bachelors in psychology and cognitive science and (two years later) is looking to start a career in the mental health field?

I mostly work on the legal end of things, so I'm not too qualified to answer that.

If I could make a wish? Come work in one of the state mental hospitals, and start influencing the decision makers around here. Bring a good heart to the industry.

Honestly? No matter where you go, bring a warm heart, and I'll be happy. It's not just a career. You're changing lives in this field. PLEASE don't be discouraged by the nearly 90% failure rate you'll face. There are good people here who can be helped. Help some of them, and pay attention to the success stories. They'll help you lay your head down at night with a smile.

Do you have volunteer help at your facility? I have been thinking of volunteering somewhere and I'd like to help people. I live near a "developmental center" and every time I drive by the thought of volunteering crosses my mind.

Well, my department gets volunteers in a bit of a "backdoor" way, so it's not a walk off the street kind of thing.

However, I do know that volunteering in any department isn't very easy. It's often a very dangerous environment. If you want, I can look into it for you though. PM me if you'd like. :)

Your interest in such a thing is really nice to hear.

When I was young I was in three different mental facilities, and I sometimes wonder what happened to various other patients, staff etc; How well do you remember patients from long ago? Do you think you'd remember these people and their stories ten or twenty years from now? Or does it depend on the person?

Also, do you ever have someone actively reach out to you after they've been released/recovered?

First, I hope you're doing well now. :)

I remember certain people very well. It all depends on the same kind of things that I remember every day people by. A certain moment, interesting story, unique personality, etc. I know there are certain patients I'll never forget.

I've heard of certain patients actively reaching out to me after release, but never successfully. More of a through the grapevine thing.

I have been to a few mental hospitals back in the day. I never felt like the doctors helped me, more as the patients I was around who weren't off their rockers helped. This one time a 40 year old male patient I was in group with talked with me for a few hours. He told me his story and then gave me advice on how to control my depression better than any doctor. I'm 21 and am currently off all my meds. I have never felt better and happier. I still have bad days but I can control myself to an extent. I guess my question is do you see this alot and what are your opinions on patients helping patients?

talked with me for a few hours

Sometimes this is the key. It sucks, but a lot of the doctors simply don't have that kind of time to devote to their patients, and oftentimes it's all they need.

Fortunately, in the position I'm in, I get to do a LOT of this work myself. I'm constantly getting patients walking into my office just to talk about their day, and I know it helps, even just a little bit.

Edit: Sorry, missed the "patients helping patients" part. Yes, I see that a TON and I think it's wonderful. Of course, we try to monitor what's going on as much as we can though. If bad advice is being given, we know about it pretty quickly and know how to curtail such issues.

One more question for you, have you encountered a patient with dissociative identity disorder? How is it dealing with these types of patients?

Oh absolutely! Man, you just took me back lol

She was such a great person. She had about 8 personalities, mostly versions of herself at different stages of her childhood. God, she was so fun. Obviously very, very sad, but she just had such a damn good heart, you couldn't not love her.

It really wans't hard to deal with her either, or any other DID types. You simply get an understanding of their different personalities, and try to understand who you're dealing with at the time.

It's those who try to deal with these types of patients as if they're just "Bob" and only one Bob that have a lot of trouble, and usually set them off.

After all the years working, are there any big events that have happened on the job that have stuck with you and what are they?

Really, it's the little events. Things like my response to /u/oddbrandon stick with me the most, because they're the events that remind me just how human and real these people are.

We work here day in and day out, and we get pretty downhearted and sick of all this insanity (no pun intended), but once a day, at least, we're reminded of why we do what we do.

Yeah I saw that! So true, it takes a lot to handle what you do day in and out and not everyone appreciates it but you are appreciated, it's a great thing you do try not to forget it!

Thanks dude. I try every single day to keep co-workers in good spirits. It's hard to keep reminding people that some good comes of what we do when we don't see it often.

Are psychopaths patients at your facility? If so, what is it like dealing with one?

Sure, we see psycho/sociopathy often. It's just kind of hard to diagnose.

What do you mean by dealing with one? We treat them as we do any other patient really. Of course, you run into a lot more manipulation and whatnot, but you learn quickly.

Is there anything that you think can be done to improve the field, and the care provided?

I commented elsewhere about the different direction mental health is going in, at least in New York state. It's really great.

Basically, we're moving to more long-term care solutions, and getting away from band-aid jobs.

Unfortunately, it's a cycle I've seen come around before. I hope it sticks this time.

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First off, I don't see it often, so I can't speak about it with much authority. I'll try though.

Where I'm working today, they do not practice ECT, but I travel all over the place from hospital to hospital, and many of them do.

I think there are definitely some legitimate effects of ECT, and I've seen it work wonders first-hand. In those cases, yes, it's worthwhile.

However, I understand completely where you're coming from when it doesn't work out, or seems like it could have been avoided. I see lots of cases go before a judge where a patient is contesting an ECT treatment.

As with anything that's so shocking (seriously tried to avoid the pun) you're going to get a lot of resistance to it.

I'm not sure if you'll see this but here it goes. I have a personal belief that we shouldn't treat schizophrenics as if their hallucinating. My thought behind this is that if something seems 100% real to you, then its real. Who am I to tell someone that their reality doesn't exist? So basically my question is have you seen any treatments that follow this? And have you met any doctors with similar ideas?

Treatments for schizophrenia are changing rapidly, as are treatments for all manner of mental illnesses/disorders.

In conversation with these patients, we're often instructed to not necessarily indulge them in their disillusions, but not necessarily downplay them either.

We've been taught to tread a very fine line with certain types of patients as those in my department are not involved in their treatment, but more so their legal issues.

Do you have any advice for somebody who thinks that they are a little crazy? I've managed to acquire a social group of such people and I wanted to try to keep them under control

I don't want to just say, "Those who are crazy, don't know they're crazy."

Can you elaborate?

Do you have any stories about anyone who works in your psychiatric center mistreating or abusing patients?

More than I'd like to admit. If you don't mind being more specific, I'll try to detail one. There just really are a lot to choose from.

Anything you're willing to share, wether it be verbal, physical, or sexual abuse. I'm interested to know how often people misuse their power when dealing with patients that maybe can't understand what's happening to them because of mental health issues.

I want to get to a lot of other questions, so let me at least leave you with a personal statistic.

On an average day, I get approximately 70-80 incident reports. This covers a section of the county I'm currently working in.

Of those 70-80, approximately half of them are neglect or abuse by caretakers.

Expand that to cover the whole county, the whole state, the whole country, the world.

Yep.

Edit: Keep in mind, many of those are baseless. Still, enough of them are found to be true.

How are high-functioning but self-destructive patients perceived?

I'm on the ADHD-Bipolar spectrum. Typical flashy type with histrionic and narcissistic traits. Often confused with BPD. Once I was in such a classically hypomanic state, the night nurse insisted the ER resident interview me. The resident entered the interview room awkwardly. I told him immediately he should enter any psychiatric-interview room defensively.

I've been managing my disorder for 23 years. I rarely, if ever, disclose my illness to friends, employers, and professors. I assume responsibility for my actions. However, I slip up sometimes. I abuse substances occasionally. Once every couple of years, I sink into a depressed impulsive state due to substance abuse resulting in lame-ass suicide attempts.

I wonder whether patients like me frustrate and confuse psychiatric professionals.

I had to think on this a bit before responding because I wasn't sure how to.

Frustrate? No, definitely not. But it does get difficult sometimes. When it comes down to it, they're professionals and know how to spot issues. But some patients are very good at intake. They learn how to talk to certain people and what to say, and when. Those types can be come difficult.

In the end, because the system is multi-level, they'll get cared for. Maybe not properly, resources and whatnot, but they'll get help.

I have heard storied of family's locking you people because they don't really understand a simple problem or they blow it out of proportion. Is that true? Wouldn't a doctor see through that or is to easy to lock a person away at the say so of a guardian?

Doctors are very good at seeing through such things.

We get shitty parents trying to get their kids locked up ALL THE TIME and I fucking hate it. It takes every ounce of energy for me to not lose my shit on these people during intake.

I'm near seething just thinking about it.

Have you ever come across a patient that had such an insane thought process that what he said actually intrigued you? Almost like someone who is "supersane". If so, can you elaborate on some of the things he or she would talk about?

Is that like Dragon Ball Z?

Seriously though, I think I get what you're saying. And yes, I've had a bunch.

One of the more recent ones reminded me a LOT of that character from the sci-fi movie, The Cube. The super-genius math guy?

He functioned okay day in and day out, but he just seemed to be way too smart for any normal person to be able to handle. Hard to explain.

Can you tell us a story about poop being somewhere it wasn't supposed to be?

By the sound of your username, I think you can.

what do you think of the closings of facilities and the opening of "regional centers for excellence"?

also, do you feel they should be closing one of the maximum security centers that is centrally located b/w upstate and downstate?

Yeah, we had a few big meetings about the RCE's. The facility I work at will be renamed to an RCE.

I think it's a crock of shit, honestly. Lipstick on a pig. They need to keep making progress with the community, which closings will help achieve. I just don't like them renaming these places as if they're some sort of safe-haven for the mentally ill. We're FAR from being able to refer to them as such.

As for the maximum security one, do you mean Mid-Hudson? I forget which is closing. Either way, I think it's fine. The hospitals designated to take on patients will handle it alright. There's bound to be issues, but if it allows the state to free up funds to further the plans for long-term care, I'm for it.

Do you think it is better that the crazy people are out on the street now? I think it was better for society and them when they were more locked up in the 60s, but I am not an expert on this field. Some people can make it on the outside, but a lot of them cannot (I feel), I know that a lot bad things happened in the hospitals, but not everything was bad (I imagine). What do you think about this?

I'll try to be as careful with this response as I can.

Those who are "crazy" and on the streets after having been seen by doctors already, those who are released with mental illness? They're often released because the hospital cannot help them any further, and they were determined to not be a threat to themselves or anyone else.

The way it has been for years is very revolving-door. A patient with a mental illness comes in, is seen, is band-aid treated, and sent back out. The band-aid falls off, they have an episode, and they wind up back in.

The way it's starting to go now is MUCH better. We're trying to get things now to where we can have a patient come in, get treated, and instead of being thrown back into society right away, be given a plan to re-introduce themselves to society.

There is a LOT of positive work being done to provide programs and help for people to not have to repeat the cycles they've been used to for all these years.

It's only just starting to take effect, but it's amazing so far, and I'm excited to be a part of it. People are finally starting to get real help.

Work around upward of 200 psychotics a day and nobody bats and eye. Play a video game and everybody loses their shit!

How can you tell me that you haven't been affected by the things you've seen and endured? If you have any empathy for those that you have contact with, then you will admit that you are a changed person.

How can you tell me that you haven't been affected by the things you've seen and endured?

I can't. I am absolutely a changed person. I have more empathy for every day people than I did before.

I often am a lot less cynical about things, even though cynicism runs in my blood. I just tend to have a greater insight into people's behavior, and therefore have developed quite a bit of patience and understanding for why every day people do some of the things they do.

Especially with substance abuse. I never thought I'd "get it" as well as I do now.

How do schizophrenics fare, in your experience? I'm living with my boyfriend's family and my living here has been a catalyst and triggered "episodes" in his brother that his family just keep playing off as his Asperger's. My grandmother was schizophrenic and it's painfully obvious to me that his mental state is well beyond autism... but he refuses medical treatment, and while I really would like him to get the help he needs, I'm sort of wondering what that might entail.

Definitely do your best to get him help. The type of anti-psychotics I see used now are VERY effective. I see people living great lives day-to-day.

HOw do you help patients get legal assistance for free? I mean do you work through their insurance, or just fight the county for good public defendants? If you can't answer, it's fine.

I kind of can't answer, I'm sorry.

PM me if you'd like.

Is Amanda Bynes a patient there??

No, but I got to interview the "train pusher" not too long ago here in NY.

sweet!

More depressing than sweet, but yeah, it was a popular dinner-talk for a while.

Could you elaborate? If you're talking about one of the subway pushers from a while back, do you mean the guy or the heavy Hispanic woman who did the same thing a couple weeks later?

It was a woman, Erika Menendez. She wasn't that heavy, but damn was she fucking angry and racist.