I'm 30, F, and work in a state hospital in California and have for the past 5 years. I've also worked in other group homes, step down programs,and summer camp like environments for all kinds of populations ranging from autistic kids to hospice care for the dying.

First of all, I speak for myself and of my experiences, and don't speak for my employer in any way. I'll also change some details of any stories I share just enough to protect patient confidentiality.

State hospitals are modern day mental hospitals. I am a licensed psychiatiric technician, which means trained in basic nursing (I can administer medications, render CPR, breathing treatments, handle feeding tubes, give insulin, injections, draw blood, do sterile procedures, etc.) but I am also trained in crisis management and have a background in psychology, some needed for my job and additional training because I'm interested. It is not labeled as a prison but it functions similar to one. 75% (estimate) of the population of patients are labeled criminally insane, behind a barbed wire fence and police presence. These usually fall into two categories, those who plead guilty by reason of insanity and are serving their time or those who are mentally incompetent to stand trial and we are attempting to restore them to competency so they can go to trial in the first place. Their trial outcome could be regular jail or prison. 25% are civil commitments, meaning anything from being on a conservatorship, a 5150 hold, drug OD, severe dementia/brain trauma, etc.

Every day is very structured - very similar to prison life but the patients have a few more freedoms. Most are on mandatory medications. Staff members wear alarms, which are GPS monitored and send an immediate signal to police when activated. We also wear a backup whistle. The majority of conflict is patient/patient or patient/self, but there are attacks on staff. It is a hospital, not a prison, so the hospital police do not carry guns. I believe they carry pepper spray but I have never seen it need to be used. I have seen medications and therapy work, and I have seen numerous patients become completely different people, be released, and fully integrate back into the community.

I have seen a lot, and not all of it is negative.

I currently work with the 25% that are civil commitments, mostly doing medical work but I have worked in both areas. AMAA!

I sent proof of my ID to the mods and was verified, I just have to keep this confidential!

Comments: 344 • Responses: 9  • Date: 

jwilli79110 karma

What has been the most rewarding moment in your career thus far?

nurseratchet15193 karma

  • Seeing patients leave the hospital, knowing you had an effect for good and that your job is effective. Also being by someone's side as they took their last breath but their family couldn't make it in time, and probably every year the staff serves a full Thanksgiving dinner to all the patients and those with good behavior are permitted to invite family, including kids, and they all share a table and meal. That's pretty special.

nurseratchet15132 karma

There are very few discharges and an awful lot end up spending close to life there, so being present when a patient manages to successfully complete treatment makes me happy

Geodud384 karma

Whats the food like where you work? Sorry i try to ask reasonable questions but curiosity always takes over.

nurseratchet15113 karma

eek, horrible! Jail food, i'd imagine. But they get a full meal, sometimes little treats like ice cream or pie. Cafeteria style and they can order snacks or family can bring them food.

ofacealoneface74 karma

What are the challenges of having long term patients vs. acute psych care?

nurseratchet15127 karma

oh my god, everything. Imagine a floor of 30 women, mental age of children, sleeping 4 to a room. Half are trying to hurt themselves, half are paranoid/hallucinating/manic and about to hurt someone else. Boredom, repetition, feeling sick and not knowing how long you'll be there or if you'll get out. But long term residents mean good rapport with staff members who know them well and can anticipate behaviors.

Arceres34 karma

Hi! What would you think to be the the most common cause for the patients behavior in terms of psychiatrical conditions?

nurseratchet1562 karma

(Just clarifying, I am not a doctor.) What do you mean behavior in terms of psychiatric conditions? I'll assume you mean negative behaviors. I always remind patients you're not here because you are mentally ill, you are here because your behaviors are unacceptable for society. This starts with a good patient history and proper diagnosis. Maybe that behavior is the only way they've learned to get attention or soothe themselves. You'll see a lot of patients used with co-existing substance abuse, often times an attempt to self-medicate

Skallagrim132 karma

What do released patients do after they've been released? I assume most try to get some jobs, but do they stay in the closest town or do they move further away? What about taking up education?

nurseratchet1543 karma

They're offered some education and work experience - I actually have a table in my living room they refurbished in the woodshop. Usually they are released into a lower security, unlocked facility or stepped down slowly, some are released to family

UVERdude24 karma

Are there any entry level jobs available in state/mental hospitals for those with a degree in psychology?

nurseratchet1529 karma

I'm actually not really using my degree! I had to go back and take anther specialized program, but now I get extra money for having he degree

lazyfrenchman9 karma

Is it PC to call them mental hospitals?

nurseratchet1519 karma

I believe so. An argument could be made against it. I know there are specific etiquette for using patient vs individual

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nurseratchet1517 karma

The mods told me my proof was sufficient, do I need to supply more?