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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Jeroen on November 30, 2008, at 14:14:48
this is latest news from schizophrenia.com
The locking of mental health patients into their wards in NHS hospitals makes them more likely to be violent, harm themselves and refuse medication, new research shows.Treating people with depression, schizophrenia or manic moods as if they were prisoners is designed to promote safety, but increases the risk of them attacking nurses or fellow patients, according to the study by London's City University.
'A locked-doors approach is more likely to leave the patient seeing the ward as a prison, themselves as prisoners and the staff as jailers,' said Professor Len Bowers, who led the research. He found half of all hospital wards which look after those being treated under the Mental Health Act use a 'locked doors' approach.
But Bowers and his team found that it leads to patients feeling frustrated, stigmatised and depressed, and that can result in them being unruly. The policy increases the risk of physical aggression to others by 11 per cent, self-harm (20 per cent) and refusal of medication (22 per cent). The study found that while patients held this way are 25 per cent less likely to escape and commit suicide outside, those who cannot go out are more likely to feel worthless and suicidal.
Strict security does not reduce the 150-strong toll of such patients who take their own life each year, said Bowers. He argued that wards should be unlocked, with staff placed at the entrance to check who enters and leaves. There are about 10,000 people in the UK on acute psychiatric wards
Posted by Phillipa on November 30, 2008, at 14:24:57
In reply to Locked wards 'harm patients', posted by Jeroen on November 30, 2008, at 14:14:48
Jeroen things may be different here but so many felt safe in a locked ward as their voices were saying someone would hurt them in the outside. My experience only with working in one. The patients trusted us and usually a day or so later would start back on their meds and begin to get well. Now this is only my experience. I can see where long term hospitalization would be depressing. Love Phillipa
Posted by Jeroen on November 30, 2008, at 14:26:16
In reply to Re: Locked wards 'harm patients' » Jeroen, posted by Phillipa on November 30, 2008, at 14:24:57
yes long term hospitalization is very depressing,
Posted by Phillipa on November 30, 2008, at 15:38:02
In reply to Re: Locked wards 'harm patients', posted by Jeroen on November 30, 2008, at 14:26:16
If you were home what would you want to be doing? Love Phillipa
Posted by desolationrower on November 30, 2008, at 15:39:00
In reply to Re: Locked wards 'harm patients', posted by Jeroen on November 30, 2008, at 14:26:16
yes it is like the prison-industrial complex in america which mass produces criminals. People should be better integrated into community not locked up. only because it is now expected to work 60 hours every week people get pushed out of social networks that protect and redirect their actions and get put into special facilities where they are taught to not respect themself and that they can't self-set goals and achieve.
-d/r
Posted by Jeroen on November 30, 2008, at 16:23:49
In reply to Re: Locked wards 'harm patients', posted by desolationrower on November 30, 2008, at 15:39:00
youre right
Posted by Zyprexa on November 30, 2008, at 19:45:04
In reply to Locked wards 'harm patients', posted by Jeroen on November 30, 2008, at 14:14:48
I was in 3 mental hospitals, all had locked wards. I managed to find a way out of one of them, but chose to stay in.
I have no opinion on which is worse.
Posted by mav27 on November 30, 2008, at 23:26:15
In reply to Locked wards 'harm patients', posted by Jeroen on November 30, 2008, at 14:14:48
Yeah after my stay in hospital earlier this year i now refuse to ever go back... i was feeling more depressed than ever so i went into the hospital.. it was the first time i had been there in 8 years. Turns out now they have changed it so the ward is locked. I couldn't handle it at all.. i became so suicidal and was freaking out and felt like a prisoner.. i started having panick attacks so they took me to another section where its even higher security which was basically 1 padded locked room with nothing but a bed in it.
Next time i feel suicidal i won't be going anywhere near the place for help.
Posted by Maria3667 on December 1, 2008, at 12:16:30
In reply to Locked wards 'harm patients', posted by Jeroen on November 30, 2008, at 14:14:48
Hi Jeroen,
A friend of mine has been locked up in a psychiatric ward several times and he claims it didn't help him.
I asked him: "What would be the right treatment for someone with severe mental problems?"
He said: "Just keep on going with normal day activities like working and playing sports. And besides that, have some psychological counseling. But don't go to a mental hospital. It won't make things better."
I've known him now for about 10 years and he's working as a computer operator. Eventhough he is still depressed sometimes and finds it hard to make friends, he claims it beats being 'inside'.
Just my thoughts.
Love,
Maria
> this is latest news from schizophrenia.com
>
>
> The locking of mental health patients into their wards in NHS hospitals makes them more likely to be violent, harm themselves and refuse medication, new research shows.
>
> Treating people with depression, schizophrenia or manic moods as if they were prisoners is designed to promote safety, but increases the risk of them attacking nurses or fellow patients, according to the study by London's City University.
>
> 'A locked-doors approach is more likely to leave the patient seeing the ward as a prison, themselves as prisoners and the staff as jailers,' said Professor Len Bowers, who led the research. He found half of all hospital wards which look after those being treated under the Mental Health Act use a 'locked doors' approach.
>
> But Bowers and his team found that it leads to patients feeling frustrated, stigmatised and depressed, and that can result in them being unruly. The policy increases the risk of physical aggression to others by 11 per cent, self-harm (20 per cent) and refusal of medication (22 per cent). The study found that while patients held this way are 25 per cent less likely to escape and commit suicide outside, those who cannot go out are more likely to feel worthless and suicidal.
>
> Strict security does not reduce the 150-strong toll of such patients who take their own life each year, said Bowers. He argued that wards should be unlocked, with staff placed at the entrance to check who enters and leaves. There are about 10,000 people in the UK on acute psychiatric wards
Posted by SLS on December 6, 2008, at 7:28:59
In reply to Re: Locked wards 'harm patients' » Jeroen, posted by Maria3667 on December 1, 2008, at 12:16:30
I believe in keeping locked wards for those patients who are in need of allowing someone else manage their survival for them because their illness makes it difficult for them to manage it for themselves. I was in a locked ward for severe psychotic mania on two occasions. It is the only environment in which I would stay the length of time necessary to find a treatment to get me past the acute psychotic episode. Unfortunately, they couldn't do anything for the depression.
- Scott
Posted by yxibow on December 6, 2008, at 19:44:37
In reply to Re: Locked wards 'harm patients', posted by SLS on December 6, 2008, at 7:28:59
> I believe in keeping locked wards for those patients who are in need of allowing someone else manage their survival for them because their illness makes it difficult for them to manage it for themselves. I was in a locked ward for severe psychotic mania on two occasions. It is the only environment in which I would stay the length of time necessary to find a treatment to get me past the acute psychotic episode. Unfortunately, they couldn't do anything for the depression.
>It depends on the hospital and current standards of care. I agree that for those who cannot manage themselves to a severe point should be considered for a locked ward only if their safety and the safety of others is in jeopardy.
Otherwise, if the hospital has an unlocked wing for those voluntarily admitting themselves, I think it says to the patient that they should probably stay to be helped but if they are deemed not a risk, they can check out on their own nature.
Today, with the expense of medical care, being admitted into a hospital, any kind, but equally a psychiatric ward because of disparity of insurance even if there is theoretical parity for some people today, unless one is sure they will conduct a suicidal plan or feels that they absolutely need medical care to get off of or adjust medication, a hospital is not the best place to be.
It lacks familiar faces and familiar voices and removes people from contacts with peers for the most part. Yes, I've heard arguments that this may be favorable in some cases because family life is not as favorable as my situation, maybe I project, but its something not to just be taken lightly. Its really a 911 situation for the most part.Because in some cases, one might as well be in a hotel or an outpatient clinic, if they're trying to escape a situation in a non-violent manner and need solitude.
-- Jay
Posted by Phillipa on December 6, 2008, at 20:25:55
In reply to Re: Locked wards 'harm patients' » SLS, posted by yxibow on December 6, 2008, at 19:44:37
Jay in this case that Scott mentions I feel we should agree to disagree as worked a locked ward and when a patient or client, person is really manic they at the time are not responsible for their actions. Someone needs to keep them safe til meds kick in. After the episode some are so embarrassed by their actions in a locked ward. One problem with mania is the patient loves the great feeling and really doesn't want it to go away and sometimes very difficult to convince the client they need meds. Scott I'm sorry your depression wasn't helped. Love Phillipa
Posted by yxibow on December 7, 2008, at 3:30:39
In reply to Re: Locked wards 'harm patients' » yxibow, posted by Phillipa on December 6, 2008, at 20:25:55
> Jay in this case that Scott mentions I feel we should agree to disagree as worked a locked ward and when a patient or client, person is really manic they at the time are not responsible for their actions.
I'm not referring to the type of ward you worked in -- people are put on 3, 14, whatever day holds in this state and a lot of states, and yes, that's because they are not in a state where they can even evaluate themselves.
Frequently it is the homeless mentally ill that end up in that state and then are tossed right back out, that is if they've been doing PCP or something. Of course sometimes they end up in the ICU part of the hospital anyhow because of alcohol poisoning.
But you're entitled to your views as someone who worked there, I'm just saying that a "hold" is not always just, it is based on some bias from the police at a situation, not that they can enter the ward armed, or at least there used to be a lock box, but anyhow, it is not always pleasant to the client who is actually more aware and functional than those who are overstaffed and evaluating people.
Someone needs to keep them safe til meds kick in. After the episode some are so embarrassed by their actions in a locked ward.
Well actually I had embarassment with some of my treatment in the hospital in the first place, because it was getting my shower and washing time down in stages and I was pulled out of the shower naked before I finished by some large people of a certain race that are usually kept around for such purposes. Sorry, but its hard not to have some racism and anger at the way one can be treated, and this was an unlocked ward.
One problem with mania is the patient loves the great feeling and really doesn't want it to go away and sometimes very difficult to convince the client they need meds.
Hmm.... well there was a patient who was on Prozac, you could amost say she was slightly manic, but that is one possible view of how Prozac can jumpstart some people to begin with.
Well I can say that I've been in what used to be both for a voluntary treatment for my OCD, the open ward was boring but 100% different from the closed one. As I was not of age quite yet but was deemed to be an adult, I walked out of there home after I couldn't stand it any more, and of course I was placed in the locked ward.
Boring, patients completely different from me, nurses station a joke, several people restrained in beds, listless patients with few to talk to, not that camaraderie is a state of mind in a lot of hospital visits since they're so short unlike my exception (which doesn't exist now, you just don't stay that long, its bankruptcy at $5+k a day or whatever its gotten to now), I was moved back after a 3 day hold I think because it wasn't moving my treatment anywhere. Besides boring, rather frightening and basically no visits.
Not that the open ward was a picnic nor was the treatment, but they did give the patients who were cooperating a chance to have escorted visits of the community and there was a nurse who I talked to frequently who took some interest in my story and life.
The adolescent and underage ward would have been locked and it was felt that I would not really have been on par with whoever was in there.
-- just my personal experience that I think mental wards of hospitals vary wildly in the way they handle patients and are just one of the many reasons for JCAHO certification issues.-- Jay
Posted by SLS on December 7, 2008, at 6:56:26
In reply to Re: Locked wards 'harm patients' » Phillipa, posted by yxibow on December 7, 2008, at 3:30:39
Hi.
Do you feel that there is something inherently wrong with the concept of forced hospitalization, or is it that you feel it is a good idea, but that in many instances it is being administered poorly?
Perfectly reasonable people at Thanksgiving can become psychotically ill by Christmas and kill your parents to comply with the wishes of a prophetic dog. Might it be desirable to hospitalize such people if they can be identified prior to acting on their psychotic thought disturbances?
Where would you draw lines, assuming there are any that need to be drawn?
- Scott
Posted by yxibow on December 7, 2008, at 15:28:06
In reply to Re: Locked wards 'harm patients' » yxibow, posted by SLS on December 7, 2008, at 6:56:26
> Hi.
>
> Do you feel that there is something inherently wrong with the concept of forced hospitalization, or is it that you feel it is a good idea, but that in many instances it is being administered poorly?No I don't think there's anything wrong with forced hospitalization for those who fit the description of being in immediate harm to themselves or others, which is what a doctor would have to do, and the police also would have to do also, in their non-scientific judgment, in general, in the US at least.
I absolutely would agree with the statement that it can be administered poorly if you have staff that aren't really concerned and just go around giving people Haldol to calm them down and mismanage medication. Strapping people down in restraints when it isn't necessary because the patient becomes compliant with medication. All these and more have occurred in hospitals in the past and I'm sure still continue in underfunded hospitals today.
> Perfectly reasonable people at Thanksgiving can become psychotically ill by Christmas and kill your parents to comply with the wishes of a prophetic dog. Might it be desirable to hospitalize such people if they can be identified prior to acting on their psychotic thought disturbances?
You can't be prophetic. There is no crystal ball in psychiatry. If the person dumps their medication or shows significant disturbing signs, during the holidays, signs of things that 911 should really be hearing, yes, they and their prophetic dog should be taken post haste to a hospital.That's when you call 911, that's when you are walked into a ward. Well actually you're not, you and everyone else is still sitting around in some locked waiting room for hours unless you arrive in an ambulance. But yes, you get the point.
You don't just put someone in a locked ward over Christmas because though they're suffering they "might be better". In fact, the ward would probably not admit them because there's no signs of anything occurring other than fugue and they have beds that are filled.
In that case, they're better home with a family or a caretaker, yes, there are always RISKS in life -- but the BENEFIT could be that they might survive through the holidays better than being locked in and strapped down and feel even WORSE over the holidays for no reason.>
> Where would you draw lines, assuming there are any that need to be drawn?You've pretty much described a scenario where I would draw the line, if someone with a known illness is muttering about channeling the power of hell through a pitt bull with the kitchen accessories, I would highly suggest to call 911 and they would end up on a hold.
But just because an ill bipolar or schizophrenic patient is facing the holidays doesn't mean that they need to be driven to the hospital at 80 miles an hour and made to feel even worse about themselves than they might already feel.
They need some sort of either home or community support -outside- a hospital in whatever they and the people around them view as the Here and Now.
That's only humane.
I mean I have some sort of never seen before psychosis NOS with my vision and sometimes auditory, really just exaggerations of normal psychiatric vision but hypervigilence and some discontinuity.
I certainly don't fit any category of homicidal idealization and my suicidal idealizations (not actual concrete things) though they have been there in the past and have gotten a little better perhaps with changes in medication, I don't need to be in a hospital.
I'm fairly intelligent though things are trapped in a medical and psychiatric fog at times and I don't need to hurt the people around me.
I know its going to be tough without therapy around for a bit and I probably will be more depressed unless I go to a party with the few people I still know or do some proactive work over vacation, and this is revealing a bit more than I wanted to about my situation, but I'm trying to point out that the holidays are a tough time for everyone and there is a sliding spectrum of when it really is necessary to seek 911.
> - Scott
>-- tidings
Jay
Posted by Phillipa on December 7, 2008, at 19:32:54
In reply to Re: Locked wards 'harm patients' » SLS, posted by yxibow on December 7, 2008, at 15:28:06
Wasn't the topic locked wards? Did I miss the holidays? I never myself saw a patient mistreated. I did witness patients being protected. Just an example please don't take this wrong in many instances the manic truly manic patients stripped off their clothes and that's a horrible memory to have if at home and they were to run down the street naked. Where I worked their dignity was very important. They would be asked to go put clothes on and if wouldn't then we would put them in a special room with 10 minute checks and dress them. So this spared them the embarrassment of others seeing what was going on with them. Some also can become violent not that they want to or spend so much money even at home with internet buying or long distance telephone calls in the middle of the night. With three shifts a patient that is very manic can be spared what could come to bankrupcy, or sex with many others that they normally wouldn't have. A parent can't stay awake 24 hours a day but severe manic patients can. Never in my experience as a nurse was a patient not seen by a magistrate in 72 hours and based on behavior, doctor assessment, and the judges observations kept any longer than necessary. many had no insurance we cared for them the same as those who were wealthy. My experiences with extreme manics was positive nothing felt better than to see their meds take effect and see them come down so to speak. Our locked ward was not for med adjustments just severe psychotic breaks, mania, schizophrenics who went off their meds and were of danger to self. One I remember found a dead racoon on the road and was cooking it to eat. His Mother also was a well controlled schizophrenic and recognized the need for her Son to be hospitalized. And All were happy endings. Usually during the holidays the unit was almost empty. Love Phillipa . Jay I'm truly sorry you had such a negative experience in the hospital I mean that with all my heart.
Posted by Phillipa on December 7, 2008, at 21:16:09
In reply to Re: Locked wards 'harm patients' » yxibow, posted by Phillipa on December 7, 2008, at 19:32:54
I just wanted to add that a great deal of the patients were voluntary admissions as some feared being in the outside world and felt safe locked in. Delusions of being killed relieved to know no one unauthorized could get in. Sorry I See The Thanksgiving holidays now. But Also would add that for the safety of the patients to allow roaming could possibly mean the patient returning with a dangerous object or street drugs. I just believe that we delivered excellent care and patient surveys after going home gave excellent reviews. Love Phillipa
Posted by yxibow on December 8, 2008, at 13:21:54
In reply to Re: Locked wards 'harm patients'addendum to my pos, posted by Phillipa on December 7, 2008, at 21:16:09
Well I guess let's say I agree to disagree. And I think, trying to to be offensive, there is some recall of when you were seeing patients at a somewhat earlier era in time -- I don't know.
Things have changed a bit here rapidly in what you'd find in a decent Level I trauma hospital and the rest of them, what they can do for emergency treatment for organic conditions, let alone psychiatric situations.
But at any rate, the concept of a "patient" is really why NAMI calls people now who have mental illness "consumers". You go to your doctor, therapist, talk, etc, and get your service, just like you would from your hair cutter, for example. It doesn't make people feel like an object.
I don't know how many examples I have to make that there again (why do we need exaggerations....) is that there is a difference between a person who is clearly not making rational decisions for themselves and is in immediate danger of harm, whatever, channeling through dogs, running with scissors, I mean we can come up with a lot of pretty offensive things....and those who are rather depressed and are experiencing emotions over the holiday, and well, someone else may think they should just be in a hospital, but I must press that isn't really the best place to be if you have any support system at all, even the minimum, outside a hospital.
Having a therapist or doctor go over with you ways to get through the holiday season -- and yes, that includes myself as well, and using coping strategies, relaxation, etc., is much better in the long run because it means you don't have to get into a situation where one dwells on everything and feels they must be in a hospital over what, the entire month of December?
Because in the long run, therapeutic and medical strategies should be in a recovery mode, and people, consumers, should be using stragies so that going to the hospital is kept to a minimum, considering that at least here, that really isn't a concept -- you aren't going to get the observation that you get with a doctor in an outpatient clinic even if you think that is an odd statement -- people are visited by both staff and if they are terribly lucky, by family, not very often over a stay.
A hospital is a place for life-threatening illnesses and women in labor and yes, people with complete plans on how to end it all, but only for short visits, and there isn't necessarily a reason to lock the door and strap them down.
Voluntary admission to a hospital is just that, and it should be that. If the ward is running itself correctly, the most ill would be observed more carefully and wouldn't be wandering the streets if they came in anyhow.
-- anyhow my 2c-- Jay
Posted by Phillipa on December 8, 2008, at 13:42:25
In reply to Re: Locked wards 'harm patients'addendum to my pos » Phillipa, posted by yxibow on December 8, 2008, at 13:21:54
Maybe one of the differences that one was a private hospital and to be a Tech you had to have at least A Bachelors In Psychology. The Other Hospital A New Unit And Restraints Were A last Resort And in Those Cases At The 72 hour hearing most sent to Another hospital. But it may have been a while since I worked but was recently told that the criteria for admission now is suicide, psychosis, Mania, Scizophrenia. So no med changes anymore. Jay I'd never wish the hospital on anyone at anytime. I've also been in one so have been on the other side. But Treatment was very good for me that is. Own bathrooms and showers and all kinds of referrals to others like neurologists. Being locked didn't bother me personally as I knew that is the way the system works. I think a lot of us are having hard times now also. But your're a wonderful person to me and truly emphathize with your horrific condition. May you continue you quest for wellness. you will suceed. Love Phillipa
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