Opinion

Restoring dignity: A teenager’s insights into inpatient psychiatric admission

Editor’s note: Healthy Debate has agreed not to publish the name of this author over concerns the diagnosis of bipolar disorder will affect future academic endeavours.

My family was no longer my family. In my state, they seemed to be empty shells of people controlled by men with an agenda – to torture me. After I had mustered the courage to give a friend permission to tell my parents, I ended up in a hospital emergency room. Except to me the hospital was not an ordinary hospital. There were cameras everywhere, just watching me suffer. They were watching me during the eight-hour wait to see the emergency doctor, and they were there for the additional four-hour wait to see the psychiatry team.

I am confident that if I was not with my mother at this time, I would have left the tormenting emergency room behind and embarked on a quest to find the men controlling the people around me. I had no impulse control, no safety awareness and a deteriorating sense of reality.

I am no expert in emergency triage, but what I know is that my family had to beg for a doctor to see me because I was repeatedly moved down the priority list. During the initial eight-hour wait, there was zero communication by any health-care provider. I may not have had bleeding in my brain, but I felt like my brain was on fire.

There were no beds left for me on the psychiatry ward, and my symptoms subsided enough for me to be sent home. One week later, I was back in the same emergency room with hallucinations, racing thoughts, grandiose ideas and a decreased need for sleep. This was when I was first diagnosed with bipolar disorder, and I spent the next few weeks receiving inpatient treatment for the acute manic episode.

As a 19-year-old Health Sciences student with a new patient perspective, I’m sharing my observations in the hope of stimulating discussion and advocating for young people experiencing acute mental health crises.

Anyone suffering an acute mental health crisis needs to know that there will be people in the emergency room who care and recognize the difficulty of waiting in such a high level of distress. No one should have to wait eight hours to have an initial assessment, and if so, there should be communication along the way by health-care providers. There’s growing evidence that peer-support services in the emergency room aid young adults experiencing difficulties with mental illness. Peer support involves having people available who have lived experience with mental illness, but are further along in their recovery, to offer support to patients in need.

I may not have had bleeding in my brain, but I felt like my brain was on fire.

Putting up to four people in an acute psychiatric crisis in the same room to sleep may be cost effective but is detrimental to patient well-being. During one of my first nights in the ward, I entered my room to find numerous nurses and security guards trying to medicate my roommate while she was held down after previously assaulting the nurses. In my heightened state of anxiety, I thought that if I slept next to her, I would be strangled in my sleep. After begging the nurses for new accommodations, I ended up in the only available space to sleep, the isolation room. It’s the only room in the psychiatric ward that sleeps one person because it’s meant for someone with an infectious disease. No other patient is worthy of privacy on the ward, I guess. Subsequent nights were spent next to a roommate vomiting in opioid withdrawal, and across from someone sleep-screaming due to hallucinations. During this admission I needed a brain rest, but the overwhelming external stimulation made it difficult to follow my course of treatment.

At 19, I was too old for the adolescent ward but not feeling quite ready for the adult ward. Nothing magical happens on your 18th birthday; people in their late teens and early adulthood greatly benefit from the family involvement that’s included on the adolescent ward, but less so on the adult ward. Especially when it comes to bipolar disorder, it’s usually the family’s role to pick up on early symptoms of mania or depression, which is why it’s crucial there’s an option to involve family in young adult care.

My experience is not in a vacuum. In Canada, 2.4 per cent of people live with bipolar disorder, and many of them require hospitalizations. Bipolar disorder typically presents itself in people’s late teens or early 20s, which stresses the need for specialized young adult inpatient resources.

Now, I have withdrawn from my semester of university, and what I lack in traditional education I have gained in first-hand experience. I have learned about the gaps in acute psychiatric inpatient care, which I hope to somehow improve in the future. I am learning how to take on a new lifelong illness in stride, knowing that the illness will present its challenges, but that I have the potential to live a fulfilling life. This I cannot undertake on my own; it will take a supportive team of nurses, psychiatrists, friends and family to give me the tools to live with bipolar disorder.

I have learned how to be empathetic to others around me. Both people in conflict with the law and the under-housed were my roommates, and they are just as human as me.

It would be impactful if everyone could spend time on the psychiatry ward as an observer because mental illness is a great equalizer – the wealthy and the impoverished live under the same roof, eat the same crappy food and take the same “wellness walks” every morning.

What seem like obvious changes to inpatient psychiatric care, like private rooms, young adult cohorts, peer support during admission and timely assessments could help restore dignity for those going through a mental health crisis.

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9 Comments
  • Kerri says:

    Beautifully written. Thank you.

  • Susan Joyce says:

    Thank you so much for your honesty and courage, as well as your striving for change. I have been to where you were, with a loved one in crisis, and it is a scary place. Change needs to happen. Every person matters. You are correct that a bleeding brain would never be left for 8 hours as you were. Our system is underfunded and overworked, given that so many are in need of urgent and effective help. I agree with your recommendations: privacy, and peer support at time of admission. I also support the residential model,( e.g Eli’s Place) for those who have been in crisis and are on the recovery journey… a stable, supportive compassionate place can restore hope and health.

  • Nancy L says:

    There needs to be more stability in the service of health and wellness. I received from the article that people will always relate a hospital as a place to get better and to recover from an injury or illness. What changes is their experience inside the hospital. A bit of a merry-go-around ride or house of mirrors. For this young lady and all patients Hospital administrators need to look at this.

  • Gary Westover says:

    A nicely written piece. I’m sorry about what the writer has gone and is going through. But, perhaps, their clear, resonant message will help improve psychiatric care for young adults.

  • Colin Gillies says:

    Thanks so much for your courageous and heartbreaking story. There are so many things to get angry about when hearing about your journey. Mental illness might be invisible but it is not less significant for that. Your 8 hour wait is an example of the lack of awareness even the medical professionals still possess. What is to be done? Your excellent story reveals so many gaps and inadequacies in the current system (though some hospitals are much better than others in that regard). It could serve as a template for how to design and create a much more humane and supportive clinical system as well as addressing the ancillary issues such as supportive housing, peer support and information for families who are experiencing the crisis of a loved one and more… Who will take up this issue?
    So glad to know you are entering the healthcare field where you can bring your awareness and empathy to the vulnerable people you care for. Stay well!

  • Gail MacKean says:

    Thank you for putting in the time and effort to share this important and very personal story. Your wisdom SHOULD help to drive change in our healthcare system. We have such a long way to go to support young people, and really all people, going through a mental health crisis and then to flourish as they continue to live with their mental illness. I’m also a huge fan or peer support and family support, with family ‘defined’ by the ‘patient’. All the best to you as you continue to make a difference.

  • Elizabeth Rankin says:

    Thank you for your courage to submit your story. When I studied Nursing in the 60’s I spent 3 months of Psych study “getting the inside track” on “the back-wards” at the St. Thomas Psychiatric Hospital as it was called…where “the inmates” were considered untreatable and would never get out!” Fortunately the place has been closed but the buildings still stand!

    I nearly quit Nursing then and there. I clearly recognized how badly patients were treated. I wondered how I’d manage to stomach their inhumane treatment. When I approached the head nurse about a patient whom I thought didn’t belong on the back ward, she told me: “oh, you really don’t know what she is like…she’ll never get out of here…and she probably never did!
    There were several Nurse Ratchets working there (movie: One flew Over the Cookoe’s Nest) and this movie aptly described what goes on in these institutions.

    Patients literally had “no voice” then and It sounds to me from your story, they still don’t!
    I don’t know what the answer is but your experience suggests things haven’t changed much, if at all. It seems “drugs” are still the weapon of choice and I know there will be push back on this comment. Yes, there is a time for medication, for sure, but it seems from your recent experience, there is still much more work that needs to be done to help those suffering from mental-emotional disorders.
    I wish you well. Maybe your career will position you to, “First Do No Harm.”

    Elizabeth Rankin, BScN

  • Mel B says:

    There are so many gaps in care with mental health. I worked on an acute mental health unit as an RN and had a family member admitted for an acute manic episode. I believe the services provided are not enough. People feel like they are being punished when admitted not that they are in a place to get better. The worst part is in discharge. Waiting weeks for mental health care in community/outpatient is detrimental to clients’ wellbeing. Mental health needs more funding, especially during this pandemic! Don’t even get me started on the lack of proper transitional care for young adults!

  • May Uusberg says:

    Hospital emergency rooms provide basic services. On weekends my local Toronto hospital had one doctor on duty. I took in my 80 year old neighbour with anorexia to emergency, she wasn’t eating at all, and I had to speak to the receptionist three times because we were not even on her list. After 3 hours waiting on Saturday night my neighbour was given a prescription for vitamins! Shortly thereafter her relatives moved my neighbour to a hospital, then a nursing home. My neighbour died at the nice city of Toronto owned home of anorexia several years later. She told me she didn’t want to live after her beloved husband died and I informed her nurse. The nurse told me I was mistaken, and that she(the nurse) had had long conversations with Agnes(my neighbour) even though Agnes had poor hearing and had English as a second language. My neigbour’s niece was out of the country for three months.

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