Hospital Care for Physical vs. Mental Illness

In late 2008/early 2009, my husband spent a total of 16 days in a mental hospital due to a psychotic break. I recently came home after spending nearly five days in the hospital due to an emergency appendectomy during pregnancy. I feel compelled to share a few keys differences between our experiences.

  1. During my hospitalization, John was allowed to stay with me 24/7. The regular hospital makes it easy for family members to provide comfort and support to sick loved ones. Not only was John permitted to hang out with me all day, but my room even had a pull-out chair that transformed into a cot so that he could sleep over at night.When John was in the mental hospital, visiting hours were very restricted. I could only see him for 90 minutes a day, usually between 7:00 and 8:30 pm, or 1:00 to 2:30 pm on the weekends. I wasn’t allowed to join him in his room or even walk onto the ward’s floor. Instead, I was confined to the visiting room.

    Although the limited access was almost certainly a safety precaution, that knowledge was cold comfort on the day John left the visiting room weeping and I couldn’t follow him to reassure him that everything would be okay. When someone is as confused and disoriented as John was when he first entered the hospital, having a loving spouse present would go a long way toward keeping him/her calm.

  2. During my hospitalization, the nurses rallied to get a hold of John when I couldn’t reach him. John had gone home to get some clothing when the surgeon came into my room and explained that I needed to have an appendectomy, and I needed to have it now.In a panic (the surgeon had also told me that my OB would be in the room in case they needed to perform an emergency c-section at 28 weeks), I tried calling John, but after reaching his cell phone voicemail and our home voicemail, my cell phone died. I tried calling from the bedside phone, but I couldn’t remember our home number and my husband’s cell phone is long distance and the call wouldn’t connect.

    When a nurse walked into my room to get me prepped to go down into surgery, I burst into tears. Not only did she let me use her cell phone to try to reach him, but she then recruited three or four other nurses to start calling him. She also dug out my file and found our home phone number so that the nurses could alternate trying John on the two numbers. Thanks to the nurses’ persistence, I spoke with John just before I went into surgery, which was a huge relief.

    The morning after John checked himself into the mental hospital, he wanted to call me. He didn’t have his glasses, so everything was blurry, he didn’t really understand where he was, and the neurologist had evaluated John while he was half asleep, and in his psychotic state my husband had interpreted the exam as a beating.

    John wanted to call me to find out what was happening, but he couldn’t remember my cell phone number, nor did he have any quarters for the pay phone. When he asked the nurses to help him call me, they refused. After that, he became agitated, and they ended up giving him a shot of Haldol and transferring him to the intensive treatment unit.

    I might be completely off base here, but it seems to me that if the nurses had helped him call me, those last two steps (the Haldol, the ITU) may not have been necessary.

  3. During my hospitalization, the staff proactively communicated with John. During and after my surgery (the only two times we were apart), the doctors and nurses made sure that John was apprised of my status. In fact, one of the nurses actually spent a fair amount of time just sitting with John and waiting with him. I never had to sign a HIPAA release form consenting to allow the doctors and nurses to communicate with my husband; they simply did it.When John was in the hospital, I spent two days waiting by the phone for the doctor to call me and explain what was happening to John. This, of course, was after John had signed his HIPAA release form, because without it, it was guaranteed the doctor wouldn’t call. I was told I couldn’t meet with the doctor face-to-face, and when I asked for his office number, the nurses told me they didn’t have it. The best they could do was put a note on John’s chart asking the doctor to call me when he came in for his rounds.

    As a family member, I was treated more like a nuisance than a vital support person, or even someone who deserved to know what the heck was going on.

A recent post on the Bipolar Advantage blog discusses how to better help people during mental health crises, and proposes that “much of the hostility that [people who are part of the anti-psychiatry movement] have comes from bad experiences when in crisis.” I would absolutely agree.

When John had to enter the hospital a second time two weeks after his first, week-long stay, it was a real struggle to convince him to go because his first experience in the hospital had been such a negative one. I, on the other hand, have only gratitude for the people who helped me during my hospital stay.

It seems to me that mental hospitals could learn a lot about how to handle mental crises from the way general hospitals handle physical emergencies.

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6 Responses to Hospital Care for Physical vs. Mental Illness

  1. Sad the great disparity in differences in treatment and help/support for family there. However, it made me wonder, is there also a disparity in pay between mental hospital nurses and doctors and those in “regular” hospitals? You would think those in mental hospitals would require more training and be paid more, but I have no idea whether or not that is the case. Anybody here know?

    • That is a GREAT question! From what I can tell by researching it online, psychiatric nurses appear to make roughly the same amount of money as pediatric nurses, although less than acute care and surgical nurses. The median salaries for those specialties are $61,565 (psychiatric), $59,498 (pediatric), $65,246 (acute care), and $74,197 (surgical).

      It appears that nursing aides in psychiatric facilities actually make more than aides anywhere else, although barely. Median hourly wages for psychiatric nursing aides is $13.43 and median pay for general medical and surgical aides is $13.29. So it’s not a particularly high-paying job.

      As for the doctors, I believe they contract with the hospitals, so in general they also have private practice patients. On average, psychiatrists make $163,660 a year. The way their billing works is based on procedure codes, not outcomes, so that’s an area for improvement. And I guess they can’t bill for time spent on the phone with patients’ families.

      When I was in the hospital, my OB was the attending doctor on my case, so he already knew me and was invested in me as a patient. John had never been to a psychiatrist before, so he didn’t have a pre-existing relationship with any of the doctors on staff. If he had to go back to the hospital now, his current psychiatrist would oversee his care, so I bet it would be a better experience for both of us just based on that fact…

  2. aek says:

    First off, I’m glad that you and your husband are on the mend!

    This post is simply excellent at getting to the heart of what constitutes a therapeutic and healing environment. I’m going to reference it.

    Thank you for this insightful commentary.

  3. […] help and harm leading to very different outcomes the physical treatment environment made here and here. A recent post on the Bipolar Advantage blog discusses how to better help people during mental […]

  4. pumpkin says:

    I could not agree more. i have been hospitalized in a psychiatric unit three times in my life, twice when i was 16, and once more last month (i’m 20). it is a depressing experience. unless you want to stay in that prison (yes, it’s a lockdown facility, which i consider i prison), you must be compliant and submissive to whatever the “doctor” wants (meaning, taking whatever drugs they throw at you). The people that work are often hostile and abusive, and often treated me as if i was a crazy person (i’m not; i have depression and ptsd).

    you aren’t allowed to go into your room half the day or even the bathroom without having to ask someone to unlock your door, to which they will ask you why, and sometimes tell you sorry, they’re busy.

    upon visiting my grandfather at the normal hospital this past week, i was astonished at the differences. i didn’t have to sign in, i could just walk into the hospital and go wherever i wanted. my grandfather’s room was huge, and unshared (at the psychiatric facility you must share a room)–and he had his own t.v., telephone, and bathroom. at the facility i stayed at, there are two phones for the whole ward (with restricted usage hours) and two t.v.s for the whole ward. And shared bathrooms that are unlocked while you’re inside, so anyone could walk in (happened to me, and as a former rape victim, this is anxiety provoking since it’s a co-ed ward)

    I’m glad to hear that you were supportive of your husband during his stay there. Unfortunately , not to be condemning of my own family, but i did notice the remarked difference between the treatment of me by my family in comparison to the treatment of my grandfather. My mother didn’t tell anyone except for her boyfriend (and of course my boyfriend knew too). She visited me maybe once or twice during my stay. With my grandpa, she’s visited almost every day for hours and has repeatedly encouraged me to do the same. There is a great taboo about mental health in this country.

    I myself believe that there are other treatment options for those suffering from depression , anxiety, and ptsd than psychiatric medications. But as I’ve learned, with psychiatrists, that is the ONLY option.

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