It took me about a year to find a job after graduating from college, so I jumped at the opportunity to work at a local psychiatric hospital. The pay wasn't great, but I saw it as an opportunity to gain some experience in my field of study.
In this post, I'll cover:
- The
basic duties performed by employees at a psychiatric hospital
- The
different units of a psychiatric hospital
- What
it's like to work the night shift
- The
good, the bad, and the ugly of working at a psychiatric hospital
Basic Duties of a Psychiatric Hospital Employee
My official title was mental health worker. This position is
sometimes referred to as a mental health technician. It's an entry-level
position but carries tremendous responsibilities and potential liability.
- Assisting
with admissions: Part of my job was to assist patients with the
admissions process. This included checking baggage and the patient for any
dangerous objects that could be used to harm themselves or others.
- Checking
vital signs: I checked the patients' blood pressure and
temperature. This was usually done at admission and in the mornings.
Patients in the substance use recovery unit were monitored every two
hours.
- Monitoring: Mental
health technicians monitor patients for safety. Rounds were usually
conducted every 15 minutes. Patients on suicide watch or close watch often
required a separate form of documentation to verify that they were
monitored for safety. It was extremely important to monitor at night. In
some cases, you'd have to change your pattern. Patients that were highly
suicidal would try to time your bed check and then harm themselves between
rounds.
- Crisis
intervention: Everyone admitted into the psychiatric hospital was
in some form of crisis or mental distress. Some were in a mild state of
depression, some were self-admitted to the substance abuse treatment unit,
while others were admitted because they were a danger to themselves or
others.
Crisis Intervention Techniques
Crisis intervention includes using verbal techniques to
prevent a situation from getting worse. Sometimes verbal intervention is
unsuccessful and physical intervention is needed.
- Assisting
with admissions: Part of my job was to assist patients with the
admissions process. This included checking baggage and the patient for any
dangerous objects that could be used to harm themselves or others.
- Checking
vital signs: I checked the patients' blood pressure and
temperature. This was usually done at admission and in the mornings.
Patients in the substance use recovery unit were monitored every two
hours.
- Monitoring: Mental
health technicians monitor patients for safety. Rounds were usually
conducted every 15 minutes. Patients on suicide watch or close watch often
required a separate form of documentation to verify that they were
monitored for safety. It was extremely important to monitor at night. In
some cases, you'd have to change your pattern. Patients that were highly
suicidal would try to time your bed check and then harm themselves between
rounds.
- Crisis
intervention: Everyone admitted into the psychiatric hospital was
in some form of crisis or mental distress. Some were in a mild state of
depression, some were self-admitted to the substance abuse treatment unit,
while others were admitted because they were a danger to themselves or
others.
Crisis Intervention Techniques
Crisis intervention includes using verbal techniques to
prevent a situation from getting worse. Sometimes verbal intervention is
unsuccessful and physical intervention is needed.
Mental health workers and nurses are trained in using
physical techniques to safely prevent someone from harming themselves or
others. Two of the most utilized programs that I know of are Therapeutic Options and MANDT.
Psychiatric Hospital Units
Psychiatric hospitals have several units, which vary
depending on patient needs and reason for admission.
Therapeutic Unit
Most of the patients in this unit admitted themselves to the
hospital due to depression. These patients were usually not psychotic and did
not present a significant danger to others.
They still needed to be monitored for safety. This usually
consisted of 30-minute checks during the day and 15-minute checks at night.
There were usually support groups facilitated by licensed clinicians during the
day.
Substance Use Recovery Unit
Patients in the substance use recovery unit were also
primarily self-admitted or admitted with family assistance. It's important to
maintain a close eye on the patients due to physical withdrawal symptoms. Vital
signs were taken every two hours during the day. If their blood pressure
readings were too high or too low, they were transported (by ambulance) to the
nearest hospital.
Hospitals also need to be careful because some patients in
this unit are HIV-positive due to drug use. Hospitals usually have an internal
code or sign to indicate the patient's status. This is for employee safety, and
this indicator is never exposed to the public.
Working in the recovery unit was a good experience, but
watching people go through withdrawal was also difficult. The worst withdrawal
I have ever witnessed was a young man going through detox from cocaine, heroin,
and alcohol. People shake, moan in pain, and sometimes lose control of their
bodily functions. It was definitely an eye-opening experience.
Locked Unit
This unit was primarily for involuntary admission to the
hospital. These patients were often experiencing psychotic symptoms due to not
taking their medications. They also presented suicidal or homicidal behaviors.
They were screened by a trained clinician and determined to be a danger to
themselves and/or others. This is referred to as a temporary detention order or
TDO.
TDO patients were required to remain in the hospital for 72
hours before they went before a judge. The judge then determined if the patient
was stabilized or needed time for more treatment.
I spent most of my time on this unit. This was primarily
because I’m a male. Just about every shift, there was someone who needed to be
restrained, and they preferred to have more males in that unit.
The physical restraining of people and seeing them in
four-point restraints on a daily basis took a toll on me. It was physically and
emotionally draining. I realized that it needed to be done for safety, but
seeing people strapped down on a bed never sat well with me.
Night Shift
I started working the night shift, and it proved to be yet
another challenge. It was more of a physical adjustment for me than anything
else. My primary concern with the night shift was the limited staff.
Many psychiatric hospitals staff their facilities based on
census. This means that the amount of staff is based on the number of patients
or the unit. In my situation, it was usually just me and a nurse on staff with
a unit of 12 patients. Do you see how this could be a problem?
If there was an emergency, we could call for help from
another floor. Of course, this took away from their staffing and created a
domino effect. A third night staff person was usually added when the census was
around 18.
Nighttime was often when many people go into crisis. One
night, we had six admissions in one shift, which wore me out. These admissions
could be violent, and sometimes the police were needed to help make the
situation safe.
The Good, the Bad, and the Ugly of Working at a
Psychiatric Hospital
There are pros and cons to this type of work. Here are the
good, bad, and ugly elements of working at a psychiatric hospital.
The Good
This was my first job out of college, and it gave me an
opportunity to gain valuable experience in the field of psychology. I was
exposed to several treatment units and was able to learn crisis intervention
skills. I was able to get a better understanding of clinical depression by
working with patients directly and learning from more seasoned employees.
The Bad
One of the negative aspects of the job was the low pay. It
was an entry-level position, but the pay was not enough considering the level
of physical risk involved. Low pay leads to high turnover. Of course, turnover
is another major problem with these types of jobs. Many feel the risk is not
worth it, and they move on to higher-paying jobs.
The Ugly
The job of a mental health worker can take a major physical
and emotional toll. While working at the hospital, I was bitten on the arm and
had my glasses ripped off my face. I was also threatened countless times. I was
never really afraid of any of the patients, but as a human, you just get tired
of dealing with verbal abuse on a daily basis.
Overall, the Experience Was Worth It
In general, I believe that my experience working at the
psychiatric hospital was beneficial. It taught me how to handle crisis
situations in a professional manner.
I developed a thick skin for threats, insults, and abusive
behaviors. I realized that it was the illness, not the person, that was
actually lashing out at me. I learned not to take it personally. This is
difficult because we are all human, and this kind of behavior can be difficult
to ignore. This is especially difficult for a young person experiencing this
for the first time.
Experience is the only way you can improve in this area
because at the end of the day, you are the professional, and you have to
exhibit self-control.
