We’ve all seen the Hollywood rendition of what a psychiatric unit looks like: large open recreational rooms, often referred to as “rec areas,” with people walking around like zombies, others huddled in the corner rocking and/or talking to themselves with random outbursts, menacing-looking staff wearing all white giving medications to the patients, others strapping patients to their bed with a nurse around preparing a cocktail in a syringe to help the patient “calm down” and potentially a doctor as well who is dressed in his white lab coat. It is a scene that is portrayed consistently across television, film, and script and one that everybody can envision when they hear about a psych ward or psych unit at a hospital. However, few have actually seen the inside of, let alone spent a significant amount of time on, a psychiatric unit and know the inner workings that take place in these locations.
The first myth that is to be dispelled is the portrayal of the staff, nurses, and doctors that are often displayed through the entertainment industry. The direct care staff in these locations are often college-educated individuals who have knowledge in case management, psychology, sociology, or other related fields of study and are there to gain real experience in the field, which is necessary to continue their education. The nurses and doctors are also not what they are portrayed. The nurses are often as involved as the direct care staff with the patients’ daily schedule and activities through educational groups about medication or symptoms associated with common mental illnesses. The doctors are on the units daily but do not have much direct impact on the daily schedule other than their regular discussions with the clients about their medications, symptoms, and diagnoses. The whole goal of the inpatient experience is to provide a safe and monitored place to help the client get back to a baseline level through education, medication adjustment or management, and setting up referrals for support upon discharge designed to maintain their mental health.
Along with the misperception of the staff is the misperceptions about the unit itself and the activities that occur on the unit. The psychiatric unit does typically have a large common area, but they are designed for this location to be central on the unit, with bedrooms lining the hallways extending from this point. This is done to assist staff in having the ability to monitor the patients consistently and ensure their safety as well as the safety of other patients and other staff on the unit. The activities available are also designed to promote education and care for the individuals. They often consist of multiple group sessions daily that cover a myriad of diverse topics related to medication, coping skills, support development, and self-reflection to help the patients develop a plan that works for them to maintain their wellness upon discharge. Since this is the main focus, there are few “entertaining” items that are allowed on the units because of the danger that these items could pose for the clients and for the staff because of the reasons behind why individuals are on a locked unit.
Lastly, the patients on these units can be animated and display behaviors that most people would find disturbing or uncomfortable. The vast majority of what is portrayed by Hollywood are extreme exaggerations and are done for dramatic effect. Typically, patients on these units are there because they are a danger to themselves or others, and often the diagnoses seen and treated are for major mood disorders, schizophrenic disorders, or psychosis that has been induced by drugs or withdrawal from drugs or medications. While all of these disorders can elicit responses that involve symptoms like hallucinations, delusions, paranoia, and mania, the number of patients actively experiencing these symptoms simultaneously on a unit is very low, and rare to have more than a handful at a time.
The portrayal of these locations by the entertainment industry is just that… entertainment. It is not an accurate representation of the unit, the staff, and certainly not the individuals present on the unit. It is important to remember that mental illness can impact anybody.