Tag Archives: Psychiatric Nursing

Six Discoveries Made on a Psychiatric Unit

On The Mighty today, there’s an interesting article on little discoveries made at a psych ward. I seriously thought I had invented playing card games as a life saver, but apparently I haven’t. Having spent eight years on one psychiatric unit or another, I can add a few more discoveries to this list.

1. The smoking area is the coziest spot on the ward. I don’t sit in the smoking area nowadays anymore, because I don’t want to associate with my fellow patients that much. On the acute unit though, I spent hours in there as a non-smoker just because it was the best place to have good conversation with patients.

2. Not just picky eaters like me despise the food. We had relatively good food when I was first admitted in 2007, but as budget cuts took over, the quality of the food declined sharply. Now we’re lucky if we have noodles, because they are pretty much the only food that isn’t too bland to be real. If someone with a specil diet or who is a vegetarian is admitted to our unit in the middle of the week, too bad. Food is delivered in bulk quantities, so no-one gets to choose what they want to eat anymore. If you’re a vegetarian or have a special diet, you can only hope that the staff will remember to order your food specifically. By the way, the vegetarian food is the worst of all kinds.

3. “Therapy” means you’re stuck with an adult coloring book. “Work” means going to the industrial arts department. I still don’t understand how people can call day activities their “job”.

4. On most wards, you can’t access the kitchen cupboards with food in them or even get a drink outside of meal times. I am fortunate to always have spent time on wards where you could get food or drink freely, except for coffee, but an increasing number of units are locking patients out of the kitchen or its cupboards. The reason is patients often make a mess. I remember a long time ago this locking of kitchen cupboards being discussed at the intensive care acute unit (not a unit I ever resided at). One nurse rightfully said that the patients on this unit have hardly anything they can control, so why should the times they eat be controlled too? Unfortunately, he didn’t get his way and the cupboards were locked.

5. People manage to argue over the remote even though everyone has a TV in their room and there are three TVs in the day rooms. Seriously, a fund founded by one patient’s parents provides TVs for everyone in their rooms, and still oftentimes the same soap opera is on on each of the three shared TVs.

6. Every doctor has their favorite prescription medication. I am still surprised the psychiatrist at the resocialization unit didn’t prescribe Ritalin to me, because he prescribed it to practically everyone. Benzodiazepines, of course, ar handed out like candy, except to me, because I told the psychiatrist I have a family history of benzodiazepine addiction and personal experience of its withdrawal. I am 100% confident that most of the other patients on benzos are effectively addicted, but apparently they’re too unwell to ever get off their pills anyway. Did you know that “severe psychiatric illness which requires high doses of benzodiazepines” (ie. chemical restraint) is one of only a few grounds to get the drugs covered by insurance. The other three are epilepsy, anxiety disorders when a person has tried at least two antidepressants unsuccessfully, and last but not least, palliative sedation in end-of-life care.

Terrible Things Mental Health Professionals Say

Heather Clark over at Raising Rebel Souls listed some horrible things “autism professionals” say. This made me think. Professionals can be terribly ignorant about autism. I have only dealt with a few people who claimed to be autism specialists, but I have to agree even they can made insensitive or ignorant comments. Those who don’t know much about autism but claim to know enough to diagnose and support autistics, are actually the worst.

Having an additional diagnosis of borderline personality disorder doesn’t make it any easier. I met a person with BPD when I was admitted to the locked acute ward in the big city in 2007. She was forcibly discharged then readmited or threatened with forced discharge many times because, according to her treatment team, borderlines develop institutionalization behaviors if they’re admitted long-term. Quite truthfully, I am the only person diagnosed with BPD on my unit and I don’t know anyone who hasn’t developed institutionalization behaviors, most worse than mine.

It’s quite common for mental health professionals to clash with “difficult” patients on the right approach to care, and I for one am a “difficult” patient. I don’t care. I may not always make decisions or exhibit behavior that is seen as “normal”, but that doesn’t mean that professionals can look into my head and determine why I do the things I do and what consequence will truly help me. We’ve left the days of pure behaviorism and most people would consider it dehumanizing if it were applied to them. Psychiatric patients are no exception. Here, I will list a few things that professionals say about or to me that are quite frankly terrible.

1. “You have a personality disorder so you need to take responsibility for yourself.” Everyone needs to take responsibility for themself insofar as they can. That’s nothing to do with one’s diagnosis. I am told that people with schizophrenia need to be treated more directively. For instance, if I had had this diagnosis, I would’ve been asked to come back and possibly gotten my privileges taken away if I ran off the ward. Now, I’m “allowed” to wander for hours. I don’t see how my behavior is any less dangerous now that I have a diagnosis of BPD than if I had been diagnosed with schizophrenia.

2. “You are an adult (with BPD), you should be able to remember to take care of your personal hygiene.” Well, the fact that I’m an adult says nothing about my memory – which is often better in children than adults. Forgetting to take care of one’s personal hygiene may not be common in BPD, but it freaking well is common in autism. Besides, whether it is comon in people with my diagnosis, doesn’t change my abilities. My profile of abilities and difficulties should lead to a diagnosis, not vice versa.

3. “You can hold down a conversation, so you aren’t autistic.” They never realize how one-sided the conversations are, because that’s normal for a professional-client conversation. Besides, not being able to hold a conversation is but one criterion of autistic disorder and isn’t even in the criteria for Asperger’s.

4. “You are so verbally capable.” I am, sometimes. Then again, when I am not, this is seen as deliberate manipulation and I’m left without help to “think on it”.

5. “Do you want some PRN medication?” Then when I answer “Okay”, they say: “So you did know what you wanted.” No, I didn’t, or if I did, I couldn’t communicate it. Saying “Okay” to a suggestion is a lot easier than coming up with said suggestion myself.

6. “You have theory of mind. After all, you apologize when you did something wrong.” Correction: I apologize when I think I did something wrong. I apologize way more often than is truly needed and quite often don’t apologize when I don’t realize I did something wrong. That is then seen as deliberate rudeness.

These are generally comments made to me, taking into account my diagnoses. I won’t say that people with schizophrenia or bipolar disorder don’t get nasty comments thrown their way. I just can’t speak for them.

There are also comments that makke it sound as though the staff are generally uncaring. For example, one nurse often says: “Nurses are too expensive to do cleaning.” True, we need to be encouraged to clean up after dinner or coffee, but it has nothing to do with nurses’ salary.

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Medicating Away for Autism: Dilemmas and Disillusions

A few weeks ago, I saw an old post on autism and medicating and what’s the dilemma being tweeted again. It got me thinking about my own journey on the path of the medication controversy.

I first learned about autism and medication from the likes of APANA (Autistic People Against Neuroleptic Abuse) and Autistics.org. It was communicated clearly on these sites that autistics should only take medications if the right supports are in place, they’re themselves suffering (as opposed to the parents suffering from the autistic’s behavior) and if the medication is not an antipsychotic. I took this information at face value. When I was myself diagnosed with autism, I became an enthusiastic autistic advocate. I was soon disillusioned.

When the option of medication was first mentioned to me, I was miserable. I had the right supports, although I was soon going to lose them due to moving into independent living. An antipsychotic wasn’t the first medication mentioned. But it was what I ultimatley ended up on. I wrote a blog post the next day about really well-informed consent. I wasn’t really aware of the fact that I had truly been mildly coerced into consenting and that 95% of the “really well-informed” bit came from my own Internet searching rather than the psychiatrist.

I quit my antipsychotic eventually when I realized it was being used as a substitute for proper care. I used the side effects as an excuse, but really I was still miserable, only just not miserable enough for increasing my supports. I was really fortunate that the psychiatrist who ended up admitting me to the hospital three weeks later, didn’t consider prescribing me the same antipsychotic, or any antipsychotic, again.

For years, I was without daily medication. I noticed how the use of PRN oxazepam was coerced, and I wasn’t going to go along with it – unless I was truly miserable. Or unless seclusion was touted as the only alternative.

In late 2009 and early 2010, I had the worst irritability I’d had in years. I knew that I might benefit from more support, but I also knew this wasn’t feasible, and my support was okay at least. So when my psychologist proposed I talk to the psychiatrist about medication, I consented. The psychiatrist gave me plenty of inforation, including many of his reasons for and against particular drugs (mood stabilizer vs. antipsychotic and if an antipsychotic, which one). He also gave me a week to think, and I consider the consent I gave this time for taking the antopsychotic Abilify to be really well-infomred.

My dose, however, had to be increased several times. I remember once telling the substitute psychiatrist, a much less considerate doctor than my regular psychiatrist, that I felt I needed more support, but I was bluntly told off and prescribed a higher dose of Abilify. Of course, legally I could’ve refused, but the irony of informal hospitalization is that you’re mde to believe you have a choice, only you don’t. I had, after all, been threatened with forced discharge if I didn’t consent to seclusion a few years prior, and this time, I didn’t even have a home to go back to, so what choice did I have?

For three years, I did fine on a moderate dose of Abilify. I did get a low dose of the antidepressant Celexa added, which forutnately never had to be increased. Then, in the summer of 2013, I moved to my current institution and soon found I had more meltdowns. I was threatened with the locked ward, in the kind of way where nurses don’t really mean it but just want to scare the crap out of you, so what choice did I have but get my Abilify increased again. And again?

I’m now at almost the highest dose of Abilify that can be prescribed, a five-fold increase from my original dose. I’m feeling really drugged up lately and in a kind of agitated state where I’m too drowsy to get out of bed yet feel irritable nonetheless. I’ve raised this issue with the staff and my psychologist several times, but nothing has come out of it.

Currently, I’m taking an antipsychotic to manage behavior that other people suffer more from than myself while I don’t have proper support. After all, proper support isn’t needed when you aren’t a pain in the neck of the staff, and when you are a pain in the neck, it’s all “attention-seeking” and “overreactivity” and they’ll treat you like crap until you’re begging for a PRN pill. Is this what Autism Daddy means? I’m assuming he wants the right support for his son, but he doesn’t care that other people are drugged up for a dentist’s appointment. Now I know that his son is more severely aggressive than I was when I gave my really well-informed consent to the original dose of Abilify, but I’m still worried.,/P>

As I wrote in my previous post, my psychologist considers medication to be a substitute for proper support. I disagree, but I’m afraid that I just got to go along with it, and the fact that I’m an informally admitted patient only makes this a little harder.

“You Got Enough Attention Already.”

Last Sunday, I asked a nurse if I could speak with her. She said I could, but not then. A while later, she went on a walk with some other clients and I went along. Then was coffee break and I, some other clients and the nurse were chatting. All evening, the nurse was busy with other duties, so even though I periodically asked whether she had time for a talk, she never did. Then at 9:00 PM, I burst out into anger over her not being clear whether or when she could talk to me. This was when she said that we’d gone on a walk and had coffee together. “You got enough attention.”

Now let’s get the facts straight. There were other clients being attended to too whilst we were going for a walk and having coffee. Not a problem with me, but I can’t see how I was supposed to talk over my relatively private issue with the nurse at that point. I know that in legal terms, care is defined in minutes of attention, not needs being met. Then again, suppose I didn’t go for the walk or attend coffee break. Then the nurse would still have taken the other clients on a walk and had cofee with them. Would she have been any less busy then, had any more time to have a talk with me? Most likely not. Would I have been any more entitled to time with her to talk over my issue? I don’t think so, but her commetn about me having gotten enough attention, suggests I would.</P

Now let me get this real clear: I wasn’t freaking asking for attention per se, I was asking for a talk about a specific subject. If all I needed in my mental health care was enough attention, why would we hire expensive nurses, social workers and psychologists for it? Couldn’t a high school student meet the same needs? The thing is, in reality sometimes all people need is attention, and this is all understandable given that most mental health inpatients are rather isolated. That’s why I advocate volunteers or inexpensive workers being hired by mental health agencies to provide activities or a simple chat about the weather with the patients. That walk and coffee break didn’t require nursing supervision. Then again, that talk I wanted to have surely did.

I didn’t touch here on the connotations of the attention-seeking presumption, which are that mental health patients, and especially those with a certain diagnosis, like BPD, have an excessive craving for attention. Well, I for one don’t. I probably spend less time interacting with people than most currently mentally healhty individuals. I may sometimes draw attention to me in a negative way, but that still doesnt’mean I do it for attention. Let me just say I hate that attention paradigm that keeps floating around in mentnal health and especially personality disorder care.