[AMA] I work at a Psychiatric Hospital.

What case(s) made you the most sad?

Which made you feel most vindicated in your choice of career?

We had one women who was in and out constantly. She didn't have custody of her kids but you could tell she was really trying, it wasn't drugs, she just a some serve mental illness and she would come in and be a handful sometimes, a lot of hallucinations and speaking to voices (or internal stimuli) and we loved her. She was so sweet and kind, we felt so bad for her because she couldn't control what was happening to her.

One day we came in and found out she had overdosed and died the day after her court appearance where she was again denied custody of her children. It was heartbreaking. To answer your second question, I honestly don't. The day I leave here will be a huge weight of my shoulders, this defiantly is not my career for life.

That is terribly sad. Thank you for being willing to share it. It must be frustrating to know about these cases and also read people being so judgmental/misunderstanding against people caught in these situations.

Sometimes going into a job, you don't realise you're about to become an observer of detail that will inform the rest of your life but you can't be directly involved with. Makes us appreciate those who can do it and do it well all the more, I think. Nice to know they're out there.

I hope you get many options for your next step and get the most fulfilling one. What do you think you might do next?

Thanks, by the way, for even briefly being part of caring for people in these situations. Helping even briefly is still helping.

I've learned a lot that I think will be more then helpful in the future, being able to see signs and understand people with mental illness and how to interact with them, so I have no regrets.

I've always been interested in video game design, as it was a huge help for me growing up as a way to escape and de-stress so I would like to be involved in that I think. My original interest was in psych but I'm not sure I can do this for the rest of my life. Thank you for your question and support!

What is a movie that is actually accurate in its depiction of a psychiatric hospital or mental facility?
A lot of times they say that the patients in the movies exaggerate their condition or do stuff that is done just to shock the viewer.

The patients themselves are not over exaggerated. I've seen patients here that are very much like what you would see in a movie.

This is only one example, as their have been many, but we got a girl once who we swear had to be possessed. I'm not religious and even I had questioned myself. She would stare at you in a way that would send chills down your spine, it was just empty but also so powerful. She would rock back and forth and mutter to herself, from what we could hear it was a lot of stuff about the devil. There were times she'd grab her face and scream as loud as she could. It was honestly beyond terrifying.

I've only ever worked at this facility so I can't say for others but only recently have I seen accurate descriptions of a psych ward. Shameless did a good job, so did the Netflix version of Degrassi. Over the last decade we've seen a huge shift to more socially acceptable facilities. We have no rubber room and no jackets. We still have bed restraints and of course we still use involuntary medication injections but it's defiantly not like it's shown in the movies, or at least not here anyway. I know some faculties still have rubber rooms or use tazers.

What are the biggest red flags family members should watch for when their loved one has been diagnosed with a mental illness? (It's my son, whose been doing well since being on Depakote. But he never exhibited extreme symptoms like talking to voices. But that rambling, non stop often angry talk...)

It's hard to say because 1: I'm not a psychiatrist and I don't want to give false information as any I have is strictly experience based. 2: I only ever see patients when they are already here so their behavior changes in different environments.

All I can really say is that if you know someone who's been diagnosed with a mental illness, talk to their doctor about what you should look out for. Personally, if his medicine is working for him just be sure he keeps taking it. Probably the most common issue I see with return psych patients is they forgot or stop taking their meds (especially if they're helping because they think they don't need it anymore). Make sure they take their medicine and that they understand that them feeling better is not a reason to stop, that means it's working.

Do you come in contact with police officers a lot? How would you judge their skill in dealing with the many psychiatric cases they encounter ? If unsatisfactory, what measures do you think would mean an improvement?

All the time. We get people from all over the state so police usually transports them if they are involtarily committed. In my experience a majority of police does not know how to deal with psychiatric patients. Just recently we had a cop harass verbally and physically a 16 year old girl while he was helping us bring her inside the facility. She wasn't doing anything wrong and it was not handled well.

I'm not sure there is much anyone can do to improve that situation. Police are trained to protect people and someone who's psychotic is even more dangerous then someone who isn't because they're unpredictable. In there line of work I would personally find it hard to interact with psych patients outside the hospital. I can only do it as well as I do because I'm so used to it and asking them to require some kind of psych work history is too far a stretch.

I also wanna jump in and say I wouldn't say psychotic patients are necessarily more dangerous. Some obviously are, but the majority I have dealt with (I've been working there 6 years almost) are what l like to call "pleasantly psychotic' There definitely psychotic and delusional but honestly I've been attacked far more by people with borderline personality than psychosis haha

Oh yea for sure. I meet way more pleasantly psychotic people then I don't. I just meant that they may be perceived that way by police due to them being so uneducated on psych patents. I'm sorry I didn't make that clear.

I just want to correct you that police are trained to enforce law

Of course, you are right, I should have said that instead. Part of that does mean protecting people too though, so in this scenario if someone with mental illness is a threat to someone else they will do what they have too, regardless of that illness which they may not even be aware of.

Hi, medical doctor here. Most of my experience with psychiatric patients are mostly related to depression, personality disorders, and suicide attempts.

Was listening to this ted talks https://www.ted.com/talks/jon_ronson_strange_answers_to_the_psychopath_test/transcript?language=en

Was wondering what you thought about people like that, if they are common in psychiatric units, and if you think that there are people who are committed because it's just easier to deal with them that way, but shouldn't actually?

A line from the movie Gothika strikes a chord with me ' nobody believes you when they think you're crazy'

I'm actually currently at work right now! So I'm not able to watch the talk but I will when I get home and I'll reply to your question!

Have you ever felt uncomfortable working in your position with certain patients?

It was a huge problem when I first started working. I almost never find myself in that position anymore as I just got used to interacting with them. The only time it's still uncomfortable is when I have to do the physical check on them, which is an in the door full body check to check for scars, bruises, etc so we can't be liable if an injury occurred outside the hospital, also to check for illegal items. We don't touch their body but I still have to check under their scrotum for any hidden items and they have to do a squat and cough. It's never comfortable and it never will be!

Have you had patients who you feel did not need to be hospitalized?

I actually laughed at this question when I read it cause more then half the patients we get don't think they need to be hospitalized. We occasionally get voluntary patients but mostly it's committed patients. It's actually a nice surprise to get a patient who does want help and is willing to work with us to get it. I say all the time I don't feel like we help anyone but that's mostly because they don't want help. Sometimes they come in not wanting help but as we get their meds right and their head level, they start to accept it and that's really what it's all about in the end. Getting them stable enough to be safe and to get further treatment elsewhere.

What's the worst case you've encountered as a behavioral technician?

I realize I probably didn't answer this question well. Let's me give you some examples!

Recently we had a women who's first action on getting out of the police war grabbing another techs balls and giving him a kiss. She hit us, she put her bare breast on a supporting beam. You couldn't understand a thing the poor women said. It was rough.

Last week a women was brought to a hospital will blood all over here but no wounds. She was going on about someone killed her cats (we personally think she did it). While she was in her room at night she kept singing and "I love you" over and over. It was seriously creepy.

The worst patients I've ever had have been people who have taken synthetic drugs. They are the most psychotic I've ever seen. One guy was convinced everyone he knew were actors in a reality show, like a real life Truman show. I'm convinced to this day that he had to be faking it but it's very possible he wasn't.

I worked in a psych unit for two years, and I agree with you on the worst patients being the ones that took synthetic drugs. We had someone that came in for spice once and she went into a 2-month (at least) long psychosis where she started falling-down on purpose to bash her head into the floor about 75 times per shift. She was a 2-1 and would throw herself down in whatever way she could where someone couldn't catch her.

Man that is rough. You can even get them to calm down with meds, nothing touches them. It's like they're super human.

What are the most typical synthetic drugs that fuck people up? Also are these mostly problems from major abuse?

We were never really given specifics on what kind of synthetic drugs but I know a few occasions where it was weed and the people were likely not aware it was synthetic, probably took hits from someone else who is a dick and didn't tell them what it was. Smoke responsibility!

I've seen people come in after just one use. I'm sure it varies by person and the specific drug. Some of the synthetic users leave and never come back so I'm sure it was probably a one time experience for them with little permanent side effects.

Hi Valanio, I'm not sure where your facility is but in the UK we're seeing an increase in drug induced psychosis from synthetic cannabis called "spice", usually peaking at the same time as music events. Is this phenomena also seen around where you practice?

Also, can I ask what the policy is regarding the threshold for psychological/cognitive treatment for patients?

Am not Valanio, but I've had several close friends who worked in mental health. Every single person I've known that worked in the field has mentioned this synthetic cannabis. It was a sold as "incense" in local shops here before it was outlawed a couple years ago.

One friend I asked about it told me that typically there was very little they could do for the person except wait. Is that still true?

There is literally nothing you can do but wait. Medicine does pretty much nothing. Luckily it usually only takes a few days but sometimes we have to send the to the medical hospital and basically put them in a coma (I must be tired because I'm hardcore blanking on the term, obviously they're not putting people in comas it's just the closest thing I can relate it to right now)

We have seen gravel, bath salts, etc but I'm not sure I've heard of spice specifically, but I'm in America and we haven't received any synthetic users in a while actually so something changed in my area this year, I'm not sure!

I'm either stupid or tired or both, can you rephrase the second question?

I wish this was an easier question but damn, I've encountered so many patients who were really sick, either mentally or physically but the worst is when it's both. I don't think it's possible to pick one, some of these people have been in and out of psych hospitals their whole life. I guess patients here solely because of early trauma is the worst. They're completly unable to live their life, constantly talking to voices, constantly in a psychotic state where they don't even know where they are, you can't communicate with them, they just exist in this other world and you have to help keep them alive but there is zero hope they will ever recover.

How do you know when there is no hope for someone to recover? Can you tell when therapy will not work?

Usually the only time you can really tell someone will never recover is when it's physical. So, for example, a drug user who has been abusing drugs for so long their brain literally stops functioning correctly. Medicine won't help them. Synthetic drugs, huffing, meth, etc. It just melts their brain and the only thing left is constant psychosis. Another example is physical trauma like a brain injury.

Otherwise, there is hope for them but most patients don't seem to want that help. A big majority of our patients are drug users or have been drug users.

I know this will be burried, but I'm hoping at least OP sees this. It's something that's been bugging me for a while.

Earlier this year I had a suicidal episode and was given a 5150 by the cops who answered my parents call. I was taken to a 'psychiatric hospital' to spend the next 72 hours. I honestly consider that place to be hell. I was kept in a glorified waiting room while the staff looked for an open bed in either their actual facilities, or another hospital. There were no beds, only couches, one bathroom that did not lock, the lights were never turned off, and all the doors were locked and guarded. Despite me telling the nurse in my entrance questionnaire the medicines that I was taking, in my entire stay I did not get any medication, leaving me with severe withdrawal. I slept on one of the couches, wearing a hospital gown and socks, and nothing else, since they had taken my clothes when I was admitted. The room had about 15 patients and 1 guard, and a nurses station filled with indifferent people who made it clear that they did not care about anything. I was not given a psychiatric exam, or any diagnostic tests, so that by the end of the three days, they decided to extend my 5150 to a 5250 since they did not try to figure out anything about my situation. Some of the people I was sleeping next to were violent, or loud, or just plain mean. On my second night, after a phone call with my dad, I curled up in one of the bathrooms to cry in privacy. A nurse opened the door to bring in another patient who had shit himself and smeared it all over the walls, and I was shooed out without any follow up to how I was doing mentally.

I was transferred to another facility and all the patients there, when asked, agreed that the place I had been had a reputation for awful work. So my question is, how is this allowed? Why was someone like me, in a first offense with suicidal ideations, thrown into something like a prison with people who could've been really dangerous to be around? The only thing I learned from that experience is to not tell people when I'm feeling like that again, because I still have nightmares about going back, or worse, waking up there and realizing I never got out.

I'm incredibly sorry this happened to you and I've never experience such a disregard for a patients well being in my entire time working here. That would never happen to you at my facility. We do sometimes have this problem in our hospital ER though, they're not trained to deal with psych patients and they're often short, rude, etc and agitate patients who we get into our facility and they're completly fine. They've never been as bad as you described though, even though it's less then nothing, I am so sorry that you were treated that way. Know a lot us actually care about you and would never let anything like that happen.

Did your job give you any insight into your own mental state, e.g. made you afraid that you may end up in the hospital yourself?

Honestly, it makes me feel more sane then I ever have ha. I was always pretty understanding of my own feelings before this so I didn't gain any particular insight I didn't have before about myself, except how lucky I was despite my own personal struggles growing up.

Yes and no. Part of me is more afraid of ending up in a place like this but also because I'm so knowledgeable about it, I'm also less afraid? Part of knowing means I'm afraid of different things then your average uneducated first time psych patient, I suppose. I would be afraid of the aftermath, a psych history in my state means you can't legally purchase a gun (which is something I would like to do someday), they have a permanent record of a psych stay which can effect all sorts of things. Any ER visit or doctors visit after, you'd have to be careful what you say or you could easily be committed again.

Why is it like punishment when you get 5150d instead of being a place where you can get actual TX? Why would anyone who has been 5150d EVER admit to feeling suicidal twice?

Where I work is a very short term facility. We only mean to take patients who we can get back on their medication or start on medications, depending on if it's their first admission. I'm sure it feels very punishing to them but of course it isn't meant to be.

A lot of reasons, homeless people looking for a warm place to stay with play the suicide card for a meal and a shower. Attention seeking patients who just want someone to pay attention to them. Drug seeking patients who can't afford their next fix. Patients looking to get on mental disability require a certain amount of admissions to get and keep their check.

I'm female and have been diagnosed with Antisocial Personality Disorder and have a PCL-R score of 33/40. Three questions:

1. What is your view of people like me?

2. Have you any experience with people like me? If so could you elaborate?

3. What is the most disturbing experience you have ever had in your career?

1: That depends pretty heavily on the individual. I've known patients with antisocial who were truly amazing and I loved them to death. Others are some of the worst I've ever seen. I think the main difference between the two is how they choose to behave. All the staff is very aware some people actively choose to be problem, whether it's seeking meds or attention. We try to correct those behaviors but it seems to never help, we are a short term facility after all. So I've had good and bad experiences and I take each new person with a clean slate. I have no judgements.

2: Sort of answered this in the first question but an example is due! I knew one girl who was truly experiencing some severe antisocial, cutting herself, trying to hang herself, smashing her head against the wall, voices, etc. Some of this was behavior but we had her in and out for a year and a half. She was sexually abused and her abuser was still being allowed to come into her house because her parents didn't believe her. Long story short, she moved out, got married, got a dog, got a job. We hear about her progress from time to time and she's doing really well. We are very proud and it's one of the few times I've seen someone really benefit from our care.

3: One of the most memorable experience that scared the hell out of me, I almost quit actually, was a violent schizophrenic who was convinced the shadow people sent us to kill him. In a fit of rage and fesr once he start throwing desk, dressers, his bed, whatever he could at us. One flew right over my head. It was more the difficult to get him on the ground and in restraints. He was like 6'4 and 400 pounds. He screamed and cussed and cried the whole time. It was the first time I honestly feared for my life and it wasn't the last time and I'm sure it'll happen again in the future.

Do you work in what you would consider to be a "for profit" hospital? Have you ever seen pressure profits degrade the quality of someone's care?

I technically work in a non-profit hospital but the legitimacy of that is debatable by many. It seems sometimes we admit patients who by no one else in the entire hospitals standard needs to be there. I wouldn't say it happens incredibly often but it does and it's hard to know for sure whether this is intentional or not but the psychiatrist are paid per patient admitted so it is most definitely something that could be abused. (Technically another party is who initially decides who is presented to the doctors to be admitted, the doctors can decline but it's extremely rare they do)

We also admit many repeat patients that are clearly, to everyone, gaming the system but whether that's the hospital knowingly admitting them or not, since the repeat patients do voice suicidal intent, is also up for debate. If someone is saying they're suicidal they're seemingly obligated to admit them, if they don't then I would imagine they could be sued for it should something happen. There was a time when a doctor discharged a patient who hours later killed himself. The family sued but I don't know the outcome of that trial or if it's even finished yet.

All-in-all, the legitimacy of psychiatric hospitals and their ability to abuse the system could happen anywhere and I'm sure that it does and has happened. Whether that happens where I work, I can't say.

What's your view on involuntary treatment? Do you think a person who is a danger to themselves/others should have bodily autonomy, or is there an exception?

That's a tough subject. On one hand I agree that we should do involuntary admission, especially if the person is a danger to others, that's the exception for me. It gets a bit tricky when we are talking about suicidal thoughts and actions.

Of course, suicide is terrible and we don't want anyone to resort to that but it's so complicated because in reality, who are we to say that they can't? We have situations where someone is suicidal and they make an attempt, survive, regret it and go on to get better and we never see them again which is great. I had a family member go through that exact situation. I am glad they admitted him and it saved his life. I can see the other argument that it's their life and they should be able to choose as well though. My job is to keep them safe while they're in my care, so that is what is what I'm gonna do to the best of my ability. Whatever choices they make outside, well that is their choice.

You always hear about crazy people and the things they do, so if you have, what's the weirdest thing you have ever found in someone's body that they may have been hiding or keeping in an orifice?

That's easy. We once had a women who brought in at least two shirts worth of stuff. I mean, she literally wrapped a bunch of items in t-shirts and shoved them up her vagina. There were pills, lighters, makeup, it was basically the contents of a purse.

Oh and one time, though the hospital didn't find it, a women had a dead rat up in her vagina. Jury is still out whether it was alive before or not.