Working in a Psychiatric Hospital: The Good, The Bad, and the Ugly
It took me a year to find a job after graduating from college so I jumped at the opportunity to work at a local psychiatric hospital. The pay wasn’t great but I saw it as an opportunity to actually gain some experience in my field of study.
My official title was a mental health worker. This position is sometimes referred to as a mental health technician. This is an entry level position but carries tremendous responsibilities and potential liability.
1. Assisting with Admissions- Part of my job was to assist with patients with the admissions process. This included checking baggage as well as the person for any dangerous objects that can be used for harming themselves or others.
2. Checking Vital Signs- I checked blood pressure and temperature of the patients. This is usually done at admission and in the mornings. Patients on the substance abuse unit are monitored every two hours.
3. Monitoring- Mental health technicians monitor patients for safety. Rounds are usually conducted every 15 minutes. Patients on suicide watch or close watch are often require a separate form of documentation to verify that they were monitored for safety. It is extremely important to monitor at night. Sometimes you have to change your pattern in some cases. Patients that are extremely suicidal will try to time your bed check and then harm themselves between rounds.
4. Crisis Intervention- Everyone admitted into the psychiatric hospital is in some form of crisis or mental distress. Some may be in a mild state of depression, some may be self admitted the substance abuse treatment unit, while others are admitted because they are a danger to themselves or others.
Crisis intervention includes using verbal techniques to prevent a situation from getting worse. Sometimes verbal intervention is unsuccessful and physical intervention is needed. Mental health workers and nurses are trained in using physical techniques to safely prevent someone from harming themselves or others. Two of the most utilized programs that I know of are Therapeutic Options and MANDT.
Most of the patients in this unit admit themselves to the hospital due to depression. These patients are usually not psychotic and do not present a significant danger to others. They still need to be monitored for safety. This usually consists of 30 minutes checks during the day and 15 minute checks at night. There are usually support groups facilitated by licensed clinicians during the day.
Substance Abuse Unit
Patients on the substance abuse unit are also primarily self admitted or with the assistance of family. It’s important to maintain a close eye on the patients due to the physical withdrawal symptoms. Vital signs were taken every two hours during the day. If their blood pressure readings are too high or too low, they are transported (by ambulance) to the nearest hospital. Hospitals also need to be careful because some patients on this unit are HIV positive due to drug use. Hospitals usually have an internal code or sign they use to indicate the status of the patient. This is for employee safety and this indicator is never exposed to the public. Working on the substance abuse unit was a good experience but it was also a difficult watching people go through withdrawal. The worst withdrawal I have ever witnessed was a young man who was going through detox from cocaine, heroin, and alcohol. People shake, moan in pain and sometimes lose control of their bodily functions. It was defiantly an eye opening experience.
This unit is primarily for involuntary admission to the hospital. These patients are often experiencing psychotic symptoms due to not taking their medications. They have also presented suicidal or homicidal behaviors. They have been screened by a trained clinician and determined to be a danger to themselves and/or others. This is referred to as a temporary detention order or TDO. TDO patients are required to remain in the hospital for 72 hours before they go before a judge. The judge will then determine if the patient is stabilized or will need an extended time for more treatment.
I spent most of my time on this unit. The primary reason was because I’m a male. Just about every shift there was someone who needed to be restrained and they preferred to have more males on that unit. The physical restraining of people and seeing them in four point restraints on a daily basis took a toll on me. It was physically and emotionally draining. I realized that it needed to be done for safety but seeing people strapped down on a bed never sat well with me.
I started working night shift and it proved to be yet another challenge. It was more of a physical adjustment for me than anything else. My primary concern with night shift is the limited staff. Many psychiatric hospitals staff their facilities based on census. This means that the amount of staff is based on how many patients or on the unit. In my situation, it was usually just me and a nurse on staff with a unit of 12 patients. Do you see how this could be a problem? If there was an emergency, we could call for help from another floor. Of course, this takes away from their staffing and creates a domino effect. A third night staff person was usually added when the census is around 18. Nighttime is often the time when many people go into crisis. I remember one night we had six admissions in one shift and that wore me out. These admissions can be violent and sometimes the police are needed to help make the situation safe.
This was my first job out of college and it gave me an opportunity to gain valuable experience in the field of psychology. I was exposed to several treatment units and was able to learn crisis intervention skills. I was able to get a better understanding of clinical depression by working with patients directly and learning from more seasoned employees.
One of bad aspects of the job was the low pay. It is an entry level position but the pay is not enough considering the level of physical risk involved. Low pay leads to high turnover. Of course turnover is another major problem with these types of jobs. Many feel the risk is not worth it and they move on to higher paying jobs.
The job of a mental health worker can take a major physical and emotional toll. While working at the hospital, I was bitten on the arm and had my glasses ripped off my face. I was also threatened countless times. I was never really in fear of any of the patients but as a human you just get tired of dealing with the verbal abuse on a daily basis.
In general, I feel that my experience working at the psychiatric hospital was beneficial. It taught me how to handle crisis situations in a professional manner. I developed a thick skin for the threats, insults, and abusive behaviors. I realized that it was the illness, not the person that was actually lashing out at me. I learned not to take it personally. This is difficult because we are all human and it can be difficult to ignore. This is especially difficult for a young person experiencing this for the first time. Experience is really the only way you can improve in this area because at the end of the day, you are the professional and you have exhibit self-control.
Would you consider working in a psychiatric hospital?
© 2014 Martin D Gardner