The Truth About Adult Psychiatric Units
Just posting this information for those who have never been to an adult psych unit, but were in a child/adolescent unit and who were threatened with and wondering about the adult system.
The following points are major differences between a child/adolescent unit and an adult unit:
1. Adult psychiatric units do not do “points and levels”. Behavior modification is typically accomplished through transfers to worse and worse facilities and increases in psychotropic medication to make you quiet.
2. You can only remain in the hospital for as long as you are dangerous to yourself or others. They legally cannot hold you in the hospital against your will if you are not going to physically harm someone or yourself. Usually civil commitment orders last for 3 months.
3. Sometimes people get arrested and then referred for psychiatric treatment and evaluation by the court. This is called “forensic commitment”. This includes Incompetent to Stand Trial and Not Guilty by Reason of Insanity, which are much longer term than civil commitment.
4. If you are actively hurting yourself or others, nurses reserve the right to restrain you. This may be a restraint chair (like the ones you see on jail shows on TV) or bed restraints. Hospitals are moving away from physical hold restraints and more toward chemical restraints.
5. If you are a safety risk in the hospital to yourself and/or others, the treatment team may put you on a 1:1 status. This means there is always a staff member within arm's length distance from you. When 1:1 is ineffective in keeping you and others safe, they may increase it to 2:1 or even 3:1 staffing where 2 or 3 staff members are assigned to watch you.
6. They assign roommates randomly rather than based on a good fit. This means, you may get a roommate you dislike and there may or may not be anything you can do about it.
7. Group therapy is optional in adult units. However, it would look good if you could attend. Aftercare placements, especially group homes, seek people interested in improving their lives and symptoms.
8. If you do not take medication, they will give you forced injections until you take it orally.
9. You may be transferred to a state hospital if you need long-term care for a psychiatric illness. Difficult-to-manage units and forensic facilities are for the worst of the worst service recipients.
10. Social workers generally do not need to warn you of a transfer to a state hospital or other facility; an ambulance may just show up and take you away in less than an instant.
Clinicians and staff need to stop threatening adolescents with an adult unit. All that happens because of this is that people become scared and don’t ask for help. In my experience, I was so afraid of an adult unit that I resisted going and had to be restrained. I probably would’ve been far less fearful and more cooperative if I hadn't been threatened with the adult unit as an adolescent.
