I am struck by the insistence on safety manifesting as stripping people of all physical objects that they could use to harm themselves. What about increasing safety by emphasizing the emotional connection that a patient has with staff members, so that they feel free to tell staff how they are feeling, and then navigate through those feelings without fear? Instead, the physical environment mitigates against emotional connection (i.e. the nursing station is often glassed off from the general hallway.)
Forgive me if I've already said this in a previous post: a long time ago, before I became a dr, I read an article about a med school program where students were required to spend a week in a hospital. I have not since been able to find this citation. It seemed to me like a brilliant idea.
Would that more programs did what yours did in terms of trainees having the experience of being dehumanized in the process of turning into a patient. I would advocate for a mandatory experience on a psych unit or in the ER!
If anyone is interested in finding a way to turn this idea into actually policy, please lmk.
I have to believe that valid research involving patient feedback on emergency room and hospital protocols would be feasible. Few people who actually want to harm themselves would take the time to cooperate in research to improve hospital policies- people don't go to the hospital to harm themselves. They harm themselves in hospitals because of pre-existing illness and inadequate care.
Clinicians have unfortunately become so disempowered in contemporary healthcare bureaucracy that their input means very little to administrators who make all the decisions and set the policies 😞
Wonderful article. So many hospitals and wards seem almost designed to harm our health, even small additions of colour in those sterile clinical hellholes that sometimes act as our homes for months or years would make a difference
And how much anti-psychiatry sentiment in the general population is due to fear of being involuntarily committed to a facility that's worse than many jails? How many people are lying to their doctor or therapist, or avoiding contact with the medical system at all, out of fear of being sent somewhere like this? How many people are terrified to even tell a family member or friend about suicidal thoughts or psychotic or manic symptoms out of fear of being committed that they might not have if inpatient units were beautiful, healing, connecting places?
It's also odd to me that fear of an occasional patient running away—or even completing suicide—is prioritized above actually successfully helping patients heal. Those actions are taken out of patient autonomy (even if judgement and perceptions are impaired) and the focus of the hospital should be on helping those who can heal and want to heal, not on making sure no one can make certain types of autonomous decision that other people disapprove of. I'm by no means saying suicide prevention shouldn't be a high priority, just that getting to zero at all costs seems to be a hierarchical control mentality, not a relational healing one. Any sort of non-abusive relationship has to include the possibility that the other does something you don't want.
I'm thinking of it kind of like a lock on a door: It's not there to keep highly-motivated people from breaking into your house, just to make it so you're not an easy or spur-of-the-moment target. I'm not sure exactly what level of security a psych ward should have for preventing suicide, but it should come from the mentality that it's there to get suicidal patients to *pause* and seek other options, not to stop the very-most-determined. And there should be increased level of security available to those who request enhanced suicide prevention in advance, but that shouldn't be the default.
I am struck by the insistence on safety manifesting as stripping people of all physical objects that they could use to harm themselves. What about increasing safety by emphasizing the emotional connection that a patient has with staff members, so that they feel free to tell staff how they are feeling, and then navigate through those feelings without fear? Instead, the physical environment mitigates against emotional connection (i.e. the nursing station is often glassed off from the general hallway.)
Forgive me if I've already said this in a previous post: a long time ago, before I became a dr, I read an article about a med school program where students were required to spend a week in a hospital. I have not since been able to find this citation. It seemed to me like a brilliant idea.
Would that more programs did what yours did in terms of trainees having the experience of being dehumanized in the process of turning into a patient. I would advocate for a mandatory experience on a psych unit or in the ER!
If anyone is interested in finding a way to turn this idea into actually policy, please lmk.
I have to believe that valid research involving patient feedback on emergency room and hospital protocols would be feasible. Few people who actually want to harm themselves would take the time to cooperate in research to improve hospital policies- people don't go to the hospital to harm themselves. They harm themselves in hospitals because of pre-existing illness and inadequate care.
Clinicians have unfortunately become so disempowered in contemporary healthcare bureaucracy that their input means very little to administrators who make all the decisions and set the policies 😞
Yes but young clinicians like you could change that! Work may be possible at the level of state medical societies, etc. But, yes.
Great article, thank you. Little to be said (or shouted) other than: “Hear, hear!”
Wonderful article. So many hospitals and wards seem almost designed to harm our health, even small additions of colour in those sterile clinical hellholes that sometimes act as our homes for months or years would make a difference
And how much anti-psychiatry sentiment in the general population is due to fear of being involuntarily committed to a facility that's worse than many jails? How many people are lying to their doctor or therapist, or avoiding contact with the medical system at all, out of fear of being sent somewhere like this? How many people are terrified to even tell a family member or friend about suicidal thoughts or psychotic or manic symptoms out of fear of being committed that they might not have if inpatient units were beautiful, healing, connecting places?
It's also odd to me that fear of an occasional patient running away—or even completing suicide—is prioritized above actually successfully helping patients heal. Those actions are taken out of patient autonomy (even if judgement and perceptions are impaired) and the focus of the hospital should be on helping those who can heal and want to heal, not on making sure no one can make certain types of autonomous decision that other people disapprove of. I'm by no means saying suicide prevention shouldn't be a high priority, just that getting to zero at all costs seems to be a hierarchical control mentality, not a relational healing one. Any sort of non-abusive relationship has to include the possibility that the other does something you don't want.
I'm thinking of it kind of like a lock on a door: It's not there to keep highly-motivated people from breaking into your house, just to make it so you're not an easy or spur-of-the-moment target. I'm not sure exactly what level of security a psych ward should have for preventing suicide, but it should come from the mentality that it's there to get suicidal patients to *pause* and seek other options, not to stop the very-most-determined. And there should be increased level of security available to those who request enhanced suicide prevention in advance, but that shouldn't be the default.