Sunday, December 09, 2007

Psychiatric Units: The Next Extreme Makeover?

Making a visit to a friend in a psychiatric ward reminds me of everything a psych unit should be and generally is not. Ostensibly places where individuals in need of respite and psychological support are sent for “healing”, all of the units which I have visited generally lack every amenity which I would consider necessary for the creation of a truly healing environment. From the institutional colors of the walls to the utter lack of homey touches denoting any notion of soul, most psychiatric units still seem to lack the humanistic qualities that readily foster recovery, wellness, and normalcy. Hospitals---whether they be psychiatric or otherwise---sorely lack the amenities and cutting edge philosophies which could actually create truly healing environments.

In the unit which I recently visited, there is the poorly named “Relaxation Room”. Here, I was not surprised to find institutional furniture (what else could there be?), one bright fluorescent light fixture in the ceiling, and a maddeningly lame collection of plastic bins desultorily littered with colored beads, dry white rice (for “tactile stimulation”), an empty bottle of bubbles, and other detritus perhaps thought to have therapeutic and “crafty” benefits. In said relaxation room, there was no source of music. In an effort to create a sense of relaxation, one entire wall was covered with an enormous piece of wallpaper showing a life-size beach scene in a useless attempt to give the individual “relaxing” in the room a sense of being at the seaside. Two deflated bean-bag chairs sat lazily collapsed against the wall. The room is anything but relaxing. It feels more like a glorified closet, a dubious afterthought of pretend holism.

What might there be in a true “Relaxation Room”? A fountain. A selection of ambient, classical, and other calming music. A video monitor on the wall from which the patient can choose various nature scenes to watch and meditate on. Full-spectrum lighting and/or therapeutic lighting. Inspirational books written by spiritual leaders and others who offer words of comfort, solace, and empowerment. Meditation cushions. Clean and soft carpeting for doing yoga or stretching.

On a psychiatric unit, where can patients spend time? In the tiny “Relaxation Room”? A non-descript and highly uncomfortable “dining room” with hard wooden chairs and tables? Where is the exercise room, complete with yoga mats, exercise balls, and other non-threatening materials without sharp edges or other risk factors. Where can a patient really work off some steam? Where does one go to run, or to roll on the floor and stretch? How can physical health and fitness be so utterly overlooked when restoration of health is so paramount?

As for food, why can’t it be served “family style” at a long table, where patients sit together and pass food back and forth from serving dishes, fostering community, interaction, and socialization? Why must everyone receive their individualized institutional tray and sit---isolated and disconnected---as they “nourish” themselves?

Where is the garden? Where are the full-spectrum lights which studies have shown can counteract the ravages of Seasonal Affective Disorder? Where are the inspiring books, DVDs, and magazines? Where are the “healing clowns”, visiting musicians, poets and artists? Where are the plants and the stuffed animals? Where, dammit, is the comfort?

The “kitchen”, open for “nourishment” and snacks, sports Salada tea, tepid water, coffee, and crackers. Where is the fresh fruit? What nutritional choices are there other than sugar, caffeine and white flour? Where are the foods that truly nourish the soul, appease the appetite, and provide some modicum of sensual stimulation and satisfaction?

The most notable evolution vis-a-vis providing radically different environments within a hospital setting is the birthing room. Expecting parents have demanded that birthing suites and maternity wards within hospitals be designed in a way which provides the comforts of home within a hospital setting. This vocal and relatively affluent group has brought about enormous and revolutionary change vis-a-vis the nature of the birthing environment. Families in labor now ensconce themselves in wood-paneled suites with king-size, four-poster beds, birthing tubs, and numerous amenities meant to provide the laboring mother and her spouse and family a comfortable and home-like environment in which to undergo the process of birth. This is revolutionary, yet this revolution has not moved beyond the walls of maternity centers, and perhaps the psychiatric units are the next frontier in need of an “extreme makeover”.

I am sure that somewhere in this country (but more likely in Europe), there exist psychiatric institutions wherein humanism and holism are paid more than just lip service. For now, the majority of psychiatric institutions in this country are most likely similarly sterile and devoid of simple yet effective changes which could lend themselves to providing a much more pleasant, healing, and effective therapeutic environment.

In the end, money talks. Birthing is big business, and hospitals compete for families and continually try to outdo one another with their “birthing packages”, offering home-like experiences for deserving and demanding (and affluent) families who want a special birthing experience within the safety of a hospital.

As for the psychiatric patients, who will advocate for their experience of improved therapeutic environments? Will the families of those who need in-patient psychiatric treatment band together and flex their economic muscle, demanding change and improvement? Or perhaps there is a Victorian-era austerity or Dickensian horror which we collectively feel is still appropriate for those experiencing “madness”. Do we still negatively label those struggling with mental illness or extreme states of mind? Do we judge those who have attempted suicide as undeserving of a beautiful, calming, and truly healing environment?

Recovery from attempted suicide, mania, major depression, affective disorders, thought disorders or personality disorders can be a life-long process. Some never fully recover and must utilize psychiatric units as if they were equipped with revolving doors. If many of our most vulnerable citizens need to visit such places, why do we hesitate to offer them the most healing and supportive environments that we can? This is not just a medical question. It is moral question. And if this question was part of a pass or fail test, we would long ago have failed quite miserably.


Anonymous said...
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Karen Johnson, blog editor and entrepreneur, certified music practitioner and greyhound trainer said...

Keith, I'm glad to hear both that you're in nursing and that you want to see a change in care for those who are not just demanding and affluent.
As a Certified Music Practitioner, I'm one of those musicians (AND I work with therapy greyhounds!) who can be found with psych patients, dying patients, and many alzheimer patients.
But, as you say, most places provide very little of the comforting, healing amenities that go a long way in giving quality of life care, even if one is nearing the end of one's life. The true patients, however, seem to be the most overlooked of all those utilizing health care.
Lately, I've also thought that there needs to be some sort of reciprocal care offered to the staff, so that they can be cared for and experience (remember) how good it feels to REALLY be given care.

klasieprof said...

Thank you for your insightful post. I just had a HORRIFYING experience getting someone admitted, and it is worse than the State Run Facility I worked at 20 years ago. NOT ONE person properly introduced was long sterile hallways...he was treated as an OBJECT not a Person in crisis. I should not have done that route. It makes me sick.