The Truth About Adult Psychiatric Units

 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. 

Return Home NJ and its Failure

Return Home NJ was an initiative launched in 2012 by the NJ Division of Developmental Disabilities NJ DDD designed to return all residents of New Jersey who are receiving DDD services and living in out-of-state specialized residential facilities to group homes and supervised apartments in New Jersey. 

While this was good for some, it proved disastrous for others. For instance, one young man with severe disabilities was returned from Woods Services in Pennsylvania to a New Jersey group home. Unfortunately, a group home setting was not appropriate for him. Subsequently, he was sent to multiple  hospitals and jail because he could not tolerate the homelike  setting. He needed more structure than a group home offered and he received that much-needed structure in jail. He was arrested after the police became fed up with bringing him back and forth to the hospital each day sometimes more than once per day. Financial resources shifted from Woods to the jail and police systems. 

Also, some individuals ended up in the State Psychiatric Hospital system, which is not ideal for those with severe disabilities.  

New Jersey has minimal facility-based programs, including the 5 Developmental Centers, one ICF in Bergen County, and the Bancroft campuses. We have nowhere like Woods Services.

DDD thought that Return Home NJ would make it easier for families to visit together in New Jersey. It is not easier to visit in a hospital or jailhouse. Many families prefer to visit in an out-of-state setting than to return to NJ and face all sorts of problems. 

Deinstitutionalization may be ideal for some higher-functioning individuals but for those with more complex behavioral and medical needs, it can be a disaster. Many out-of-state facilities are less institutional than a State Hospital or jail. A lot of specialized facilities look like gated communities, college campuses, and other “normal” settings. It may be less institutional to stay out of state rather than return to New Jersey. 

Fortunately, Governor Chris Christie put an indefinite moratorium on Return Home NJ, and many people were allowed to leave New Jersey and return to their specialized facilities. However new individuals are not allowed to leave New Jersey on New Jersey funds, which can be problematic if New Jersey does not develop more facility-based programs and ICFs, especially for those with severe behavioral and mental health concerns. NJ Division of Developmental Disabilities does not under any circumstances send people to out-of-state residential programs and NJ Children's System of Care only occasionally sends people out of state when all options inside New Jersey have been exhausted. This is not ideal for those for whom group homes do not work. All New Jersey has is group homes, group homes, and more group homes... 

We need more facility-based programs in New Jersey including campuses (also known as Intentional Communities) and dormitory-style locked units for those with special behavioral and mental health needs with a developmental disability and we need to allow out-of-state placements in specialized residential facilities for those with dual diagnosis.