mental hospitals more on visting | A second guest posting by Elizabeth Richter |
PART II: Visiting Practices at Connecticut Psychiatric Hospitals Reflect Antiquated Assumptions
     In a recent visit to my friend, Libby, who was staying at a psychiatric hospital, I came too early for the one hour of visiting time available, and so I had to give up on the visit. Hoping that the entire enterprise wouldn't be a loss, I then turned my attention to the task of getting my presents to Libby. Just before arriving at the hospital, I'd bought a lovely vase of daffodils and a large plate of cookies at the nearby Big Y.
     "Could you pass along the bouquet of flowers?" I asked.
     "No." was the answer.
     "Why not?"
     "Because you aren't allowed to bring anything breakable onto the ward."
     I looked more closely at the flowers. Oops, the vase was made of glass.
     So how about the plastic tray of cookies-could I pass them along?
     "No." was the answer
     "Why not?"
     "Because there could be drugs in them."
     I looked at the cheery plate of Valentine's Day cookies, some in the shape of hearts, others in circles with cheery smiley faces on them, and I responded with "Drugs?" my voice going up in an inquiring tone of voice. Yes, apparently, staff thought I might have slipped drugs into the cookies.
     I responded, "Are you telling me that you think that from the time I bought these cookies at Big Y to here, I might have slipped some drugs into these store bought cookies."
     "Yes." was the response.
     "Ok, then." I said, finally losing my temper, "you may think this way, but I'm not the one who is paranoid."
     Yes, the glass I should have known better. But the cookie problem. That was not within the realm of my imagination.
     As I have stated, most psychiatric hospitals maintain very restricted visiting hours of around one or two hours a day. In addition, hospitals conduct visits according to firmly delineated policies based upon an expressed concern for the "safety and comfort" of the patients, as well as concerns regarding staffing and convenience. Some of these policies made sense, while others did not and appeared to be outdated and based upon older, punitive assumptions regarding patients.
     Many people newly admitted psychiatric hospitals are in extreme, difficult emotional states. As a consequence, it is often the standard, particularly when it comes to those who are abusing drugs and/or alcohol, to prohibit any visits within the first few days of hospitalization. This policy is based upon the idea that psych patients in crisis are too sensitive for visits from friends and relatives, but is this merely an unexamined assumption, or an actual fact?
     Those first days in a hospital, particularly for those who are in there for the first time, can be crucial in establishing a positive attitude towards recovery. Many people at this point feel particularly frightened that they will be abandoned or lose the love and care of their families. Reassurance, then, from family members and friends can reduce that sense of fragility, yet, psychiatric hospitals try to limit this support.
     It would never occur to them to impose these kinds of limitations on patients with physical medical problems to which providers compare mental health problems all the time. One mother I spoke to cynically implied that this policy was in place to coerce patients into complying with medications and treatment approaches they wouldn't otherwise agree to were they able to tap into the support of friends and family.
     Not only do psych hospitals limit when you can visit families members, they also limit where you can visit them. Currently, as is standard in prisons, visits are conducted altogether in a common area such as the cafeteria, TV room, or living room, which means everyone is visiting all at once and all together, and patients have very little privacy during their visits.
     Jim Murray, Director of Behavioral Health at St. Francis [Hartford, Connecticut] stated that this is necessary because of the problem with understaffing, and that with everyone in one location, it would be easier to rally support should an incident occur.
     However, it is my understanding that psychiatric hospitals are not prisons, and psychiatric patients are not being punished. This means they should be allowed visits in the least oppressive environment possible.
     There is also the question of who gets to visit. When I was in the hospital, and this situation remains today, you could refuse visits from anyone if that's how you felt. As anyone can tell you who has been a psychiatric patient, there is a wonderful sense of power in the exercise of that prerogative.
     Otherwise, all the power is in the hands of staff. For example, what was really funny regarding my visit to Libby was that even though the staff member there recommended that I just wait the 2 1/2 hours until visiting hours started, what she wasn't thinking of or just didn't mention was the fact that the hospital restricted all visits to family members.
     Therefore, even if I'd waited I would still not have been allowed in.
     Hospitals maintain a firm grip on who gets in and out. The majority limit the number of visitors to three or four. Staff members request that children be supervised and kept under control when they come, and those under 12 must have permission from the psychiatrist in charge.      Some places requested that the consumer provide a list of allowed visitors in advance, and of course, the inverse, a list of people not allowed to visit, which certainly doesn't allow for any spontaneity.
     Furthermore, at a place like Naugatuck, the policy states that the "hospital reserves the right to limit visiting as needed and visitors who appear to be under the influence, as well as visitors who are seen by staff as representing a threat to the safety, security and/or confidentiality of patients, or other visitors and/or hospital staff, will not be allowed to visit."
     While it seems reasonable that the hospital shouldn't be forced to accept visitors into the hospital who could be dangerous, a policy of this kind is so broad and general "reserves the right to limit visiting as needed"-what does "as needed" mean-that literally hospital staff can restrict a consumers' visitors at will. They can also assign staff members to supervise a visit at will.
     This reflects the general situation regarding everything affecting a consumer's life in a psychiatric hospital. Yes, you have many rights--the right to make phone calls, to receive your mail unread, etc., etc., but the catch is that all of those rights can be obviated if the staff think that they shouldn't have to follow them in their clinical judgment.
     What is missing are any clear cut [or consistent] guidelines--an inventory, for instance--detailing what it is that would justify not allowing a particular person to visit. In essence, such policies leave the power, almost absolute in its application, in the hands of the professional staff at the hospital. And, as in my situation, if you challenge the staff, they will bring in additional staff members to keep you in line. I was lucky enough to be able to walk away from the situation, but if I'd been captive to it, how might that confrontation have ended up--with seclusion or restraints?
     Finally, how are visits conducted? In my day, if you wanted to see me on the Hall, visitors would arrive at a locked door and face a sign indicating various items not allowed on the Hall. Depending upon what was going on, there would also be a sign warning the visitor of possible split risks.
     As appears reasonable, on a psychiatric ward, the first area of concern is to protect patients from harm to themselves and others. Thus, signs and written policies delineate restrictions that are geared towards preventing people from either causing themselves or others harm--no clothing with drawstrings, no plastic bags, no lighters, no breakable items (glass vases!!), no sharp objects, etc. At some hospitals there was a restriction on work boots, which was interesting, perhaps reflecting past experience. I guess you don't want folks with wearing work boots if you are trying to subdue them.
     Yet other policies didn't make much sense to me. One of the most difficult problems I have when my friends get into the hospital is purely getting in touch with them. Under these circumstances, a no cell phones policy seems rather regressive. Ok, so you don't want the ones that can take photos because of the confidentiality issue, but what about phones that don't take photos? Or else, if cell phones aren't allowed, is it possible to have regular phones in your room the same way that they are in your room in a hospital for physical problems?
     But no. Nothing has progressed in 25 years. Quaintly enough, the antiquated hall phone remains the central way patients and folks on the outside can contact each other. For the uninitiated, just imagine how your nerves get jangled and your thoughts mixed up when every so often your conversation with other people gets interrupted by the operator, "please deposit FIFTY CENTS for an additional three minutes" and God forbid you don't have a ton of change to pay for the calls. In many juvenile facilities, patients have to talk to callers on a phone right at the nurse's station where everyone can listen in,
     The problem I understand has to do with wires. Folks can use wires to complete a suicide, but is it possible to have a wall unit with a portable phone? When it comes to radios and CDs which may also be forbidden, is it possible to use batteries? And why are patients forced into a common area to argue over TV channels. How about TV in the bedroom the way it is in every other hospital unit. What's the problem with that? Can we be flexible here?
     Food and clothing received particular mention in terms of hospital visiting hour policies. Across the board, most of the time staff members said it was OK to bring food, although some did continue to have "no food" policies.
     Some were even willing to consider home baked goods, which I thought was a bit of a stretch--think of all the hashish I could stick in a brownie.
     Most of the staff insisted that food brought in had to be consumed on the spot. This struck me as being a rule for the sake of having a rule, of which there tend to be many in psychiatric hospitals. A few more sensible ones said it was OK to label the food and put it away in the kitchenette for later on.
     As for clothing, despite our cultural acceptance of overall exposure when it comes to the lovely shape and form of the human body, particularly the female one, many hospitals requested that visitors avoid provocative clothing.
     I'm assuming this policy originates in a fear that it would be detrimental to the fragile psyches of psychiatric hospital inmates. However, granting all the sex I saw going on in the days when I was in the hospital, I considered that unlikely.
     In the end, the psych hospital is often the first exposure patients and family have to the mental health system. Granted that, shouldn't this exposure be a supportive and positive one, rather than one littered with opportunities for the abuse of power and complicated by policies reflecting an outdated, unexamined past? Hospitals, across the board, need to ensure that this is so.  ¶ 02:44