You wake up at the crack of dawn, a few hours
earlier than you really need to. Your bed isn’t helping - it’s small, if
not completely uncomfortable, and there isn’t much room to toss and turn. You can hear noises around you - the staff
getting ready for the day’s work - and the sun is peeking through the curtains. It’s looking like a lovely day outside,
but you’re not likely to be spending much time outside. You’re in a mental hospital, and the usual
day’s routine is about to begin. You should probably get some rest while you
can - life here is strictly regimented. Your first taste of this structure comes as
it’s time to get up. At the same time every day - usually 7 AM
- you’ll hear a knock at your door. This is one of the staff doing morning checks. They want to make sure that all the residents
are okay after the night, and this is usually accompanied by a warning that breakfast will
be served in half an hour. Mealtimes are usually carefully structured,
and everyone who has the freedom to wander the facility will have to be in the cafeteria
at the right time to ensure they don’t miss the most important meal of the day. So what’s the menu like in a mental facility? In a word, simple. Think of your old school lunchroom or the
cafeteria in an office building. You can have something as simple as a bowl
of cereal with milk, or many facilities will offer diner-style breakfast options like pancakes
or eggs. How good the food will be varies by facility,
but there will usually be daily specials - so something to look forward to on your favorite
day of the week. But this isn’t just any cafeteria - the
staff knows the patients well, and any foods or drinks that might interact negatively with
medication will be kept away from residents who could be impacted negatively. So some might have to go without that morning
cup of coffee. That’s not the only area where residents’
food habits may be supervised. It’s common for residents to have one-on-one
supervision after mealtimes. This is for a number of reasons. Some might have eating disorders that would
lead them to try to purge their meal after eating it. Others, who are on medication, need to be
supervised so they take their pills with food. Others might be supervised to make sure they
don’t pocket any supplies - like utensils - that could be used for dangerous purposes
back in the room. There are many reasons someone could wind
up in a mental health facility - and they might warrant different levels of security. Some check in voluntarily for treatment. This is common when someone is struggling
with an eating disorder or substance abuse disorder - although private rehab facilities
also exist and offer a more luxurious environment to go cold-turkey. But you’re not a reality TV star on their
third rehab stint. People who are struggling with mental illness
like depression and worry that they could be a danger to themselves or others could
also turn themselves in for treatment - although once you sign the papers to commit yourself
voluntarily, you’re usually agreeing that you put it in the doctors’ hands to determine
when you’re released. Of course, most residents are not in this
facility voluntarily. Most people who find themselves in a mental
health hospital are committed involuntarily. The most common method is when they’re placed
on a psychiatric hold - which can happen surprisingly easily. If someone contacts the police or social services
believing the person is a danger to themselves or to others, it’s pretty common to place
the person on a 48-72-hour psych hold, which gives the doctors the chance to assess them. If the person passes all psychological tests
and convinces the doctor’s they’re not a risk if released, this could be little more
than a strange and scary few days. But often, the doctors recommend a longer
stay when real issues are raised - and this can be trickier when someone is committed
wrongly but is angry and terrified when questioned. But some residents are there for a more serious
reason. Treatment in a mental health facility can
be ordered by a court either at the conclusion of or as an alternative to a criminal trial. Famously, the lead of One Flew Over the Cuckoo’s
Nest convinced a judge that he was too crazy to stand trial - and got more than he bargained
for. But it’s common for a defendant who is found
not competent to stand trial to be referred to a nearby mental health facility. And in more serious cases, defendants can
be found not guilty by reason of insanity or arrange plea deals based on mental instability
- as happened to the shooter in the attempted assassination of Ronald Reagan, and the teen
culprits in the notorious Slenderman stabbing. Both were sentenced to extended stays in high-security
mental health facilities. So the residents of a mental health facility
can be a varied bunch - and you’re about to spend some time with most of them. As a resident, you’re likely to spend much
of your time in various therapy sessions, starting with community group. This is where all the residents meet with
the doctors and do some sharing and discussion with each other. You’ll be reminded of the rules of the facility,
which govern what you can have in your room, when you can use the phone or other electronics,
and how to interact with fellow residents. People air their grievances, and the staff
does their best to mediate. New residents will be encouraged to share
things about themselves and set goals for themselves. Now, it’s time for some one-on-one time. The doctors at the facility will usually meet
with the patients independently to check on their case, either in the patient’s room
or in the doctor’s office. This is so they can determine how the patient’s
medicine regimen is interacting with their mind. The human mind is a tricky thing, and changes
in biochemistry can have unpredictable results. The doctors won’t hesitate to take patients
off one medication, or increase the dose of another, to alleviate symptoms and hopefully
speed up recovery or at least equilibrium. Of course, not all cases are stable. Hope you haven’t been counting on a relaxed
time. Many patients have unpredictable disorders
like schizophrenia that make them see things that aren’t there or become convinced that
they’re in danger. It’s not uncommon to hear screams or sounds
of people punching walls or trying to break things. While the facility tries to respect its patients’
autonomy as much as possible, they are ready to sedate and restrain people when needed
to protect both themselves and others. But for those who are more stable, this is
a time for a little relaxation on a busy day. Residents can usually spend their free time
reading or playing games in the common room. It’s not uncommon for residents to form
friendships among their fellow patients - although there are some rules to follow, including
no touching and no being alone in each other’s rooms in most situations. But it won’t be long before you’re reminded
of why you’re here. One of the most important parts of life in
a mental hospital is process group. This is where you meet with your social workers
and tackle direct ways to handle your specific mental health issues. This is usually a small group where people
who have similar struggles - depression, addiction, etc - can compare notes. The social workers lead residents through
exercises to teach them coping mechanisms to minimize the impact of negative thoughts
and other challenges. These groups can get emotional, and it’s
not uncommon to see an outburst, but the social workers know how to bring things back to the
focus. Next, it’s on to lunchtime - but nothing
in this facility is irrelevant to treatment. Lunch is usually simple foods like pizza,
sandwiches, or salads. While many patients can just eat with little
supervision, any patient there with eating disorders will be monitored far more closely. They might even have a points system assigned,
which will track their diet and may set back their release if the doctors feel they’re
not making progress. And of course, any patient who has to take
medication with lunch will be monitored. The rest of the day isn’t any less busy
than the morning. After lunch, there might be different kinds
of therapy including recreational therapy - which can be as simple as watching a movie
with a group while your behavior in a semi-normal setting is monitored. There might be education groups where you’re
taught how to manage your condition once you’re hopefully released in short order. And to whet your appetite for that day, there’s
an added bonus - visitation hour, where you can see the people you love on the outside
in a safe and controlled setting. It’s not as strict as prison visiting hours,
but you’ll still likely be monitored closely. Life in a mental health hospital is usually
pretty predictable and boring - but it wasn’t always that way. Go back a few hundred years, and mental health
hospitals were a very different place. Often called the less politically-correct
“insane asylum” or “lunatic asylum”, they were really more a place for containment
of the disturbed than anything else. Treatment was basic and often involved heavy
restraints, and psychiatric medication was only in its beginning stages. While some early reports of asylums in places
like Cairo had surprisingly modern innovations like music therapy, institutions were a far
cry from what they are today. And the reasons people wound up in them were
different as well. With psychiatric science far from its current
developed stage, it was easy to get “sent to the nuthouse” for behaving erratically
in public or other social crimes. It was also not uncommon for family members
to have their own kin committed because they were acting in ways they determined to embarrass
the family - often women who were acting too independent, or members of the LGBT community
who were stepping out of the closet. And while treatment advanced in the 19th and
twentieth century, sometimes those new advances were equally barbaric - including electroshock
therapy and even lobotomies to surgically alter the patient’s personality to make
them more compliant. So do any of these barbaric institutions still
exist? While some treatments like electroconvulsive
therapy do still exist, they are carefully regulated in most countries and will only
be undertaken as a short-term solution if evidence shows that the patient could benefit
from it and they consent. Even with the most high-risk residents like
the criminally insane, the focus will be on managing their conditions with medication
and giving them a higher degree of autonomy. There was controversy when attempted assassin
John Hinckley Jr, who had nearly killed President Reagan, was allowed to be released from his
mental hospital in 2016 to live at his mother’s home - with strict conditions. While many people felt an attempted assassin
should remain incarcerated, he wasn’t in prison - he was in a mental health hospital,
and they felt he was no longer a threat to himself or others. But for you, there’s still some work to
be done - starting with nighttime. Dinner is similar to the other meals of the
day, but with heartier options. You’ll usually get a stew with meat and
starch, and some vegetable sides. Afterward, there will be some time to socialize
and unwind, and then it’s time for closure group. This is where you’ll review the day and
discuss any goals you set. This can be stressful for some if they didn’t
reach their goals, but the social workers will be quick to redirect people to look on
the positive side and look ahead to the next day. There’s just one more piece of business
to take care of. Before bed, everyone has to line up for their
nightly medication. While not everyone takes medication throughout
the day, it’s likely that everyone will be taking at least one thing before bed - often
to help with sleep. And speaking of sleep, it’s tightly regulated
like everything else. The facility has a strict lights-out time
to ensure everyone has enough time for a full night’s sleep - because tomorrow, the whole
routine begins again. And it’ll be just like the previous day
- right? Not exactly. Every day has wild cards. Routines will vary, some patients will leave,
and new patients will come in. Some days are relaxing, other days are chaotic,
but a functioning mental health hospital has one goal - to prepare its residents for the
day they walk out that door, better able to manage their condition, and be a healthy and
productive member of society. For more on life in an asylum, check out “Journalist
Goes Undercover At Insane Asylum and Becomes Prisoner”, or watch “The World’s Craziest
ER Stories” for what goes on at a different kind of hospital.
