The Politics of Mental Illness: Inpatient Psych Wards Revealed

By Erica Loberg

The current state of our treatment of the mentally ill in some inpatient psych wards is not acceptable. And those that “whistle blow” on pertinent issues and concerns surrounding our treatment of the mentally ill, and get disciplined for it, point to a real problem: What are they hiding?

Today I’m going to address three significant issues I witnessed in acute inpatient psych wards:

#1.Tuberculosis Transmission
Tuberculosis can be spread when one person transmits the bacteria to another person through the air. When a person with tuberculosis coughs, sneezes, speaks, or laughs, tiny microscopic droplets containing the tuberculosis bacteria are sent into the air, causing people nearby to breathe in these bacteria and possibly become infected.
Falling through the cracks. Sometimes a patient is admitted to the psych ER, and doesn’t get tested for TB, and is then admitted to the acute inpatient psych ward for an extended period of time. As a result, patients end up walking around exposing TB to staff and other patients. Psych ER’s are extremely busy, and things can fall through the cracks, but not informing the staff and patients or admitting such mistakes are of serious concern.
One time I had a patient that suddenly disappeared. I asked the staff of his whereabouts and they said once they discovered he had a positive chest X-Ray, he was immediately admitted to the med floor for treatment. I was shocked and disturbed to realize that a patient had been walking around with a positive chest X-Ray for weeks, exposing all that entered the ward, all that worked in the ward, and all that were admitted and waiting for discharge to be involuntarily exposed. After he was treated in seclusion he was readmitted to another ward in the hospital. The topic was never broached or discussed, and the incident was treated like it never happened. It was more or less a “don’t ask, don’t tell” situation. That’s w r o n g and it’s time to fess up to our mistakes and make sure all admissions to a psych ER are carefully tested prior to inpatient admission. It’s one thing to have a patient infested with lice and accidentally pass through the ER without proper examination, and then have an entire inpatient ward be exposed to lice, but it’s another thing to have an airborne disease like TB floating in the air for days, weeks, or even months on end.

#2. Over medication:
Why do we think that tranquilizing patients is the answer to treating the mentally ill? One reason is financial. Instead of allowing them to stay until they find the proper medications, they end up being stuffed with a plethora of medications with exuberant amounts of high dosage. A manic person that becomes a zombie is “ready for discharge.” They’re not causing any havoc on the ward and appear stable; “stable” meaning slothfully walking around and sleeping the day away. This makes them “ready” for discharge. This is not the solution to treating the mentally ill. In my experience, it was only a matter of time before they were readmitted because often times once the patient is discharged, they stop taking their meds. How can you blame them? Why would a patient want to continue taking medications that cause them to lose their ability to function properly. Mentally ill individuals that don’t want to take their meds because they don’t think they have a mental illness is one thing, BUT when a patient decides not to take medication because of a bad experience of over medication while being hospitalized, that’s another situation altogether. How can we expect sick patients to be med-compliant when they are overmedicated? I wouldn’t want to be a zombie either, would you?

#3. Inappropriate Discharges:
When a patient is discharged to the “street” it’s noted that they were discharged to “self.” One time, a resident made a flippant comment about a patient being discharged to the street and was immediately reprimanded and told never to use that term when discussing discharges. I have also witnessed patients being “dumped” when they are mentally ill and homeless – another scary word a hospital tries to hide, or avoid.
To begin finding solutions to the few issues I mentioned above, we have to take a close look at money. How are we spending it, where is it going, and why haven’t we taken a closer look at what’s really going on in mental health to better distribute the monies we need to treat the mentally ill in a positive fashion? In order to figure out how to manage and dispense funds in a productive manner, we must take an honest look at what’s really going on behind locked doors, and what we have to do financially to properly and successfully treat the mentally ill.
For example, I mentioned the rotating door of inpatient psych wards, the practice of overmedicating so patients appear “stabilized,” then pushing to get them out. It’s only a matter of time till these patients come back. However, some may argue that there are only so many beds in a ward and they are expense. So the idea is to get them out as soon as possible to save money when really they are spending more money. Are we saving funds allocated to treat the mentally ill when patients come in and out of the system over and over again?
No. But if we’re not willing to take a good look at the reality of the on goings of psych wards, we’re at a dead end. We have to start somewhere, and ignoring, denying, or refusing to admit we have a problem in the treatment of sick individual’s leaves us with a sad, cyclical system that gets us nowhere.
Having said that, I was heavily disciplined by the county when I brought forth these issues in my book, “Inside the Insane.” I have no regrets for whistle blowing and accept the retaliatory outcome of writing the book. I’m sad to say that I’m not surprised by their measures. But, the people deserve to know the truth and what’s happening in psych wards. We can’t continue to look the other way and blindly accept crucial matters that need to be addressed. And without taking responsibility on an administrative level and attempting to right current wrongs, we have no chance for change.
My only hope is to find others to support my cause and hope you take the time to think about how such issues can be addressed sooner, than later.