Visiting Hours make visiting impossible
guest post by Elizabeth Richter
Recently, I drove for two and a half hours to visit a friend in a psychiatric hospital arriving at 4:00p.m.. I had heard from a staff member the night before that visiting hours were from 6:15am to 7:15pm, but I must have heard her incorrectly, because as it turned out visiting hours were from 6:15 pm to 7:15pm--only for a single hour.
Desperately trying to salvage the situation, because I couldn't wait, I explained how far I had driven and I asked whether staff could give me a break. "No." was the answer. I shifted my ground. "Would it be possible to ask the nurse in charge and see if, as hospital policy stated was possible, she would authorize a visit outside of the standard visiting hours. "No." was the answer. I
shifted again. "Granted my lengthy trip there and anticipated lengthy trip back, would it be possible to say "hi" to my friend at the door of the ward and just give her the presents I'd brought along. "No." was the answer.
My insistence alone was so unpleasant to the receptionist that by now she had called in two additional staff members down from the ward to deal with recalcitrant me, and their faces were frozen into expressions of stony disapproval.
At a time when we are so aware of the central importance of family and friends in assisting the recovery process for people labeled with psychiatric diagnoses, what can account for this rigid response to my request?
Also, what could account for visiting hours limited to a single hour per day, in contrast to medical hospitals that have visiting hours of at least 12 hours per day and often 24 hours per day given the medical condition?
In 1978 when I was also an inpatient on a psych ward visiting hours were from 10:00am to 10:00pm. This was considered an enlightened policy and was in place as a part of a substantial reform movement on the part of the hospital. It would never occur to me that psychiatric hospitals would regressively return to restrictive policies that a prior generation of mental health professionals had deemed poorly conceived.
After my failed adventure visiting my friend at the psychiatric hospital where she was staying, I conducted a survey of hospital visiting hours at approximately 26 psychiatric hospitals in the state of CT. Three other people assisted me in this endeavor.
We determined that out of the 26 psychiatric facilities and hospital psychiatric wards that we called, during the weekday 3 had only 1 hour a day available, 12 had only 2 hours, 9 had only 3, 1 had 4, and 2 had more than 4.
During the weekends, hours were more generous, often expanding up to 4 hours per day and sometimes extending up to 7. Alice Russ Cochran Psychiatric Clinic in Derby was particularly generous in providing expanded visiting hours for family and friends, whereas Natchaug Hospital in Mansfield Center offered substantially limited visiting hours.
It is worth noting that if we tried to get visiting hour policies, in addition to information on visiting hours, staff were often reluctant to answer questions. One of my callers found the problem so difficult, he gave up the job. Often, the price of getting any information turned out to be the extent of my willingness to respond to intrusive questions about who I was, why I was asking, who I was intending to visit, for what purpose, and when. Yet when I asked one receptionist what her name was, she told me it was hospital policy not to give that information out.
Across the board, several hospitals had brochures detailing their psychiatric ward visiting policies. However, some just outright refused to send those brochures to me, while others said they would, but only one did. Some told me that they limited information regarding the conduct of hospital visits to an orientation with the patient upon his or her arrival.
But what is most important here is what I discovered-that hospital visiting hour policies appear to be constructed in order to restrict the access of friends and families to psychiatric patients. This is unfortunate recognizing how essential the support of family and friends is to recovery for those labeled with mental illness. According to one New York study, upon returning to the community those diagnosed with schizophrenia have relapse rates of 5% when supported by family whereas those who don't have family support relapse at rates of more like 40-45%. In addition, a Washington Post July 27, 2005 article by Shankar Vedantam again centrally stressed the results of a three decade long study by the World Health Organization that emphasized the vital importance of family and friends in supporting the recovery process. Shouldn't visiting hour policies reflect such insights?
I spoke to three psychiatrists regarding this issue, including Dr. Harold Schwartz of the Institute of Living, and all concurred in saying that the rationale for limited visiting hours was that patients nowadays only stay
in hospitals for very brief periods--8-10 days--and during that time they are nvolved in structured therapeutic programs that take up all of their time. As Harold Schwartz put it, "the single most compelling issue here is that the inpatient psychiatric unit has a structured therapeutic program all during the day and patients need to focus in on their participation in such groups."
Yet these kinds of statements were not backed up by patients. I spoke to one person who said that there were perhaps two or three hours of therapy groups, but after that she spent much of her time resting. Another former patient in response to the question of what she did all day in the hospital said,
"I complained, bitched and moaned and walked around in circles. At one point I got involved in an argument over which television channel to watch and another patient hit me over the head." Another sixteen year old who was in a juvenile facility for two weeks said, "I did nothing all day."
Some would speculate that restricted visiting hours is a vestige of attitudes that blame families for the onset and continual progression of mental illness. As one staff person who did not wish to be named explained, "Families and friends are still viewed with suspicion, though no one will ever say that officially."
In hospital wards treating dual diagnoses, which were the most restrictive, such policies are based upon the assumption that family is most likely centrally involved with the condition, and that friends are most likely drinking or drug buddies. To me, this points out where treating dual diagnosis in the
same hospital wards with those who are psychiatrially labeled leads to substandard conditions for the latter, and is a strong argument for discontinuing such practices.
Dr. Jim Murray, Director of Behavioral Health at St. Francis Hospital stressed additional points, i.e. the importance of keeping a person safe who is undergoing an acute crisis, the difficulty for staff of managing their resources in the face of extended visiting hours, the problems associated with confidentiality. And, of course, there are situations where family and friends can exacerbate a person's symptoms.
However, using these concerns to restrict visiting hours to a mere one or two hours a day seems like an extreme response conveying the impression that mental health professionals are defensive and suspicious of family and friends whom they see as outsiders.
The greater good of incorporating family and community support into the lives of people in crisis is a persuasive argument for extending visiting hours and adding more flexibility into the picture.