When Crisis Intake Undergoes Beneficial Changes
When I’ve felt dead inside, deeply anxious, and losing my
grip on reality, reaching out for mental health help seems reasonable, though I
fight the idea, unsure about placing my trust in the process. Will it be an
ordeal, or not? I’m referring to times I’ve been in crisis so acute that I self-harm
or consider suicide. Sometimes I’ve called 911 and had police officers escort
me to the county’s crisis center. If hospitalization is deemed as the
appropriate next step, I’ll have to go through the usual drill in an ED. Even
avoiding the middleman, meaning I take myself straight to the ED, I’ll follow a
set flow, because once the registrars have determined my reason for being there
and fastened an ID bracelet around my wrist, that’s how it plays out.
I may be told to sit in the waiting area until my name is
called. I barely tolerate this noisy space with so many people in close
proximity. I hold my body tightly in hopes of warding off the panic rising
inside of me. Walking out isn’t a viable option. Once I’m finally called back, I’m
told to remove all clothing (behind a curtain), dress in gowns, and put all
personal possessions, phone included, into a plastic bag. Guards put these in a
lock box and then scan me with a metal detector, up and down and around, until
I’m declared safe enough.
And then I wait again, maybe in an alcove within arm’s
length of other lost in the maze patients, maybe on a bed in a hallway, parked and
blocked from moving by security. I’m approached here and there by staff
introducing themselves as my doctor or nurse, who I never see again, or as a
tech drawing blood or running an EKG, who I only see that one time. Otherwise,
I’m left on my own, sitting, wondering when I’ll have a psych assessment,
contemplating what hospital will have a bed, the good unit, or one of the bad
ones. And I become nervous but there’s nobody to tell that to. ED staff breeze
past me, busy, always very busy. Why did I come here? Why? Why? I’m
anticipating the worst happening, the bad psych unit, and if I refuse, a
temporary detention order (TDO) , handcuffed and driven where I don’t want to
be and it’s all…it’s all…hitting me, my mind assaulted and rolling in the
turmoil of horrible scenarios.
 |
| me, in the emergency department last August |
All of this has been common for me and generates new trauma on top of the trauma I’ve lived with for years. Medical, psychiatric, and even patient relations staff have always seemed disinterested in hearing about it. I figured that to be true everywhere, in all instances, until the end of time. But now I’ve been proven wrong. The hospital I go to frequently is creating a far more humane environment.
I noticed changes happening in bits. First, I was moved out
of the main ED area into a hole-in-the-wall type of pod, a nurse, guards, and
police officers in the middle with 4 patient rooms branching off to the sides.
They told me this was psych overflow. The area was set up, sort of on the fly,
because psych patients are often in a lengthy wait for a bed. In this space, I
could watch TV and have snacks and food trays. It wasn’t pretty. In fact, it
had the ambience of a dive bar. But the distraction from tormenting thoughts
and the buzz of the ED was welcoming and I embraced it. I don’t know how to
further emphasize this.
But then it got even better. Overflow underwent a remodel,
brand new beds and TVs, more beds, the entire area painted in a serene blue
palette. I could almost smell the paint still drying. I felt relaxed and
noticed less yelling from other patients, their needs attended to more quickly,
the atmosphere less stimulating. Everyone was at ease, including nurses, techs,
and guards.
This is all good, yet I still carried my predominant worry
about where I’d end up. Once a psych assessment team determines a psych unit
stay is the best course of action, there’s no dissuading them. When that
happened, I could choose to go voluntarily or not. But I couldn’t choose the place.
Psych unit beds are generally on a first-come, first-served basis. I always
wanted to go upstairs because that unit is outstanding, specializing in mood
disorders. Other units are for thought disorders, patients with medical as well
as mental health needs, and adolescents. Last time I went through the ED and
hospitalization was recommended, there were no beds available upstairs. I asked
to be sent home but was told no, firmly. I was offered a bed at a below
standards unit and shot back that I’d need to be put on TDO and dragged over in
handcuffs. It all seemed like a stalemate; however, it wasn’t.
In addition to the new overflow area, the hospital now has an
alternative, a unit for patients requiring only a brief stay, less acute, and
able to self-direct treatment. When that was described to me and then offered, I
quickly accepted.
The unit is unique, a big open room with recliners instead
of beds. Recliners are spaced for a sense of privacy and push back flat for
sleeping. When I entered, meditative music played. Later, movies were shown on two
big screens. For those desiring a break from the open area, small private
cubicles line the sides, available for short respites. Patients can access
their own snacks, when they wish, from the kitchen area. Group therapies are
available throughout the day.
Stays on this unit are strictly limited to 48 hours. When I
arrived, others were there, but they left within the next few hours. Essentially,
it was just me for the following overnights. I wanted to go home, but the staff
didn’t approve of my choice. Although the unit isn’t meant as a transition into
a psych unit, that can occur. I hadn’t achieved stability within the 48-hour
time limit. I watched the clock fearing the psych unit I might face next. Then
I had good news. Just before time ran out, a bed became available upstairs. As
I was wheeled into the elevator, I took a moment to be grateful for the enhancements
in care I’d just encountered.
The changes I’m seeing are amazing, like nothing I’d ever
imagined. It’s just remarkable to me to find comforting spaces during a mental
health crisis. And that’s where comforting spaces belong! I applaud those
making decisions at this hospital for prioritizing psych care, for putting
money into these efforts that truly make a huge difference.
I encourage more inventiveness around caring for mentally
ill people and those in crisis. Some have been through the mill and know how
dismal care in these situations might be. I’m one, and I’ve come to expect the
dismal parts. For someone new to it all, perhaps anticipating gentle treatment and
kind words, the reality can be a shock. I want patients to have gentle, kind
treatment. I wouldn’t at all mind saying, “In my day, we didn’t have it so
good. But we kept discussing what was bad and how to improve it, and now we
know that reaching out for help doesn’t result in more troubles piled on.
Instead, it’s the beginning of a better life."
