In 2013, I spent four days in a psychiatric hospital unit on an involuntary hold where I discovered what it's really like inside a psych ward. Despite my fears of a full-blown Girl, Interrupted experience, I realized what I saw on TV was not quite how real-life psych wards work.
In the mid-1900s, psychiatric institutions were a free-for-all place to lock up anyone with any kind of problem that wasn't understood. These very depressing and inhumane places provided the inspiration for the Hollywood horror movie versions of mental institutions. However, starting in the '60s, the process of deinstitutionalization reformed the systems surrounding mental health. Facilities became less isolated, released more patients, kept stays shorter, and worked to keep admission rates lower.
Still, time spent in a psych ward isn't exactly a day at the park. I have pieced together my own story with those of other patients and the research of various psychiatric professionals to create the following list. It paints a more accurate picture of what it's like in a psych facility than what you see in the movies.
Disclaimer: This article is not to meant to deter anyone from seeking inpatient psychiatric treatment, but to give a real glimpse into modern US psychiatric facilities and their strengths and weaknesses. If you or someone you know might be suicidal or in distress, call 1‑800‑273‑TALK (8255).
Most Patients Admit Themselves Voluntarily
In films, you usually see psychiatric patients being dragged kicking and screaming to their stay at a facility. However, as of 2016, approximately 75% of the 1.6 million admissions to psychiatric institutions in the US were voluntary. Of course, that doesn't mean these self-admittances weren't pressured by outside forces such as doctors, family, or police.
Still, the number is considerably higher than it was in recent history. Voluntary admittance rates were just 10% in 1949, and 45% in 1980. As the stigma and systems surrounding mental health have drastically changed throughout the years, so have the number of people willing to enter a facility on their own.
You Can Be Held Involuntarily For Weeks Before A Formal Hearing
Sometimes, if you are considered a danger to others or to yourself, you can be admitted on an involuntary basis. You might think one must be truly "crazy" to get locked up in a psychiatric facility on an involuntary basis, but that's actually not the case. While the laws on psych holds vary from state to state, in general, the criteria to hold someone for the 72-to-120-hour window for involuntary admittance is pretty minimal. It is completely up to the psychiatrist or health care professional handling the case, and in many cases, they'd rather be safe than sorry.
In some states, this preliminary psych hold excludes weekends and holidays, leading to periods much longer than 120 hours. And in some, like Louisiana and Connecticut, the initial 72-hour hold can be extended to 15 days before having to involve a judge or requiring a detailed report. This means that one healthcare professional has the power to detain someone for over two weeks without any legal recourse for the patient.
Every Psych Ward Is Different
There is no "standard" psychiatric facility. Different facilities serve different purposes, and the level of care and quality of life is not uniform due to varying resources, state funding, or staff. Any number of factors can contribute to whether a patient has a positive or negative experience.
While some facilities are structured for long-term stays (giving patients a more consistent routine), the place where I stayed was meant for short-term treatment. Patients spend an average of four to seven days at these short-term wards before being released or transferred to a long-term care facility.
Staying at a short-term facility, my personal observations were that the medical staff appeared to be less equipped and less interested in creating a beneficial experience for individual patients. They seemed more focused on checking boxes and passing the buck.
Socialization Is Strongly Encouraged
If you think you can pass the time sitting alone in your room at a psych ward, think again. Many psychiatric hospitals have shared rooms to increase capacity, meaning you'll likely have a roommate. And let's just say you don't fill out a compatibility questionnaire like you do in college.
In addition, group activity is thought to be beneficial for mental health patients. And while they can't literally force your hand at the card table, doctors will take note of your participation, or lack thereof, as an indicator of your mental state or progress.
In my case, after spending a day reading Harry Potter by myself, I was told that my lack of participation in activities like bejeweling tote bags didn't bode well for my release.