Last summer Elisabeth got me hooked on a Netflix show called
‘Girls Incarcerated.’ I found myself
drawn to it because it was eerily reminiscent of Rachel’s inpatient
treatment.
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Yep. How we treat the
mentally ill is similar to how we treat criminals. (To be fair, there is some overlap among
those two populations).
(Note: I am not claiming to have any extensive knowledge
here but am simply sharing my comments on what I observed/experienced and what
Rachel has shared about the experience.)
The first similarity is the apparel. The girls in the juvenile detention system wore
basic polos, sweatshirts, scrub-type pants, and shoes with Velcro
fasteners. Kids in inpatient treatment
basically wear t-shirts, sweatshirts (no hoodies allowed), and leggings. They often don’t wear shoes because, well,
they aren’t allowed to leave the unit so they’re unnecessary. Clothing that we provided for her had to be
checked and approved for safety measures before it was taken into the
unit.
Second is the layout/design of the unit. (I have a degree in architecture so yes, I’m
overly attentive to this stuff). The floor
plan is open so that everyone is visible at all times with all bedrooms along
one wall. I don’t remember the capacity
of the unit, but it isn’t large. Furniture
is either bolted down or substantial enough that it cannot be lifted (or
thrown). Decorations are sparse.
Bedrooms are lockable----for safety purposes. At school kids learn how to go through
lockdown procedures to keep the ‘bad guys’ out.
Well, what happens when you’re in a locked unit with said ‘bad
guy’? You are taught to lock yourself in
your room until staff neutralizes the situation and unlocks your door. Yikes.
I would later learn that Nebraska doesn’t segregate mental
health patients into units based on severity of illness. This means that kids who are suicidal (like
Rachel) are in a locked unit with kids that are schizophrenic and experiencing
hallucinations, or some who are even homicidal.
Other states have better mental health systems and classify patients for
their safety.
When we arrived for our meeting with the unit psychiatrist
the morning following Rachel’s admission, we were given a diagnosis of major
depressive disorder (mdd). They had
already met with Rachel and assessed her.
Components of treatment for this are nutrition, sleep, medication,
therapy, daylight and exercise. Seems
simple enough, right?
In the less than 18 hours since she had been admitted, she
went for more than 36 hours without food.
Due to the events of the previous day, she did not eat lunch at school
and rarely ever ate breakfast. When she
was admitted the staff assured me that they were getting her a meal tray even
though she had missed supper. We later
found out this never happened. Although
hungry, Rachel was too scared to ask the staff for food. The unit has a specific daily schedule and
when she was told to go to bed she did as she was told.
Adequate sleep has a direct impact on mental health yet for
safety purposes the staff does bed checks every 15 minutes. I understand this requirement but see how
much sleep/rest you can get when someone is shining a flashlight in your face
every 15 minutes to see if you’re still breathing. Not to mention the fact that some of the
other patients are downright scary and it’s hard to fall asleep when you’re
worried that they might hurt you.
Psychiatric medication is a complicated subject (and one
I’ll address in more detail in a future post) but she was on medication at the
time of admission and they were to continue administering it as directed. In less than 18 hours they had made two major
mistakes with her medications: they completely missed her evening medications
and they medicated her incorrectly in the morning.
She was then sent to group therapy which was likely
unproductive for her since she could barely stay awake due to the medication
she should have had at bedtime and instead received at breakfast.
So, just to review..........at this point she had not received
adequate nutrition or sleep and had been improperly medicated which led to a
day’s worth of therapy being practically worthless. (Note: For any nurses reading this, please
understand that I realize you’re human and that you make mistakes. When these mistakes were brought to their
attention they did take steps to correct the situation. This is simply describing my frustration at
the time, it is not a criticism against the nursing profession.)
Daylight is also critical to mental well-being, yet these
kids are never allowed outside and there is minimal natural light and some of
them remain in this unit for a month or more.
Even the kids on ‘Girls Incarcerated’ got time outside. They spend their time sitting or laying
down---no exercise.
In their free time, the other patients taught Rachel
creative new ways to turn household objects into tools for self-harming. One involved breaking a regular plastic
clothes hanger a certain way.
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Fabulous. If I
thought our house wasn’t safe for her before……
I began to question if this was really an improvement in my
effort to keep her safe. Jeff’s
resistance to this line of treatment was looking more and more logical.
Needless to say, it clearly wasn’t the optimal solution I
was looking for and the next day we requested she be discharged. They wanted to keep her one more day, but
after acknowledging that nothing would materially change for her in 24 hours,
our request was granted and we brought her home with arrangements made for her to
begin the partial hospitalization program the very next day.
The main benefit of inpatient treatment was that it provided
a serious wake-up call for her. She saw
and heard what some of the other kids were dealing with and decided that she
was doing pretty well in comparison and it motivated her to want to get better. One patient that really got to her was a
9-year old boy who had tried to hang himself.
Nine.years.old.
As she talked about him she said ‘Mom, he’s just a kid.’ I sat there thinking ‘So are you,
Rachel.’ We still wonder about him and
if he’s doing better.
So, while there was no 'Nurse Ratched', the adolescent psychiatrist
for the unit was a bit……rough around the edges.
It wasn’t like ‘One Flew Over the Cuckoo’s Nest’ but inpatient treatment
still isn’t great. (BTW: Netflix is
coming out with a Nurse Ratched series this year based on the movie----you can
bet I’ll be watching).
While Rachel was being discharged another teenage girl was
being admitted. Her mom had a
shell-shocked look that I’m sure I had two days prior. I told Jeff I wanted to comfort her and tell
her that everything would be okay. He
quickly pointed out to me that I couldn’t promise her that. We didn’t even know if Rachel would be
okay. We were just moving on to the next
phase of treatment: partial hospitalization.
That’s a story for another day.
To be continued…….
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