What’s therapeutic about that?


The environment about where people are assessed and treated when experiencing a crisis of distress is critical.  Two bloggers recently addressed how much of a difference in help and harm leading to very different outcomes the physical treatment environment made here and here.

A recent post on the Bipolar Advantage blog discusses how to better help people during mental health crises, and proposes that “much of the hostility that [people who are part of the anti-psychiatry movement] have comes from bad experiences when in crisis.” I would absolutely agree.

When John had to enter the hospital a second time two weeks after his first, week-long stay, it was a real struggle to convince him to go because his first experience in the hospital had been such a negative one. I, on the other hand, have only gratitude for the people who helped me during my hospital stay.

It seems to me that mental hospitals could learn a lot about how to handle mental crises from the way general hospitals handle physical emergencies.

Many of the examples included actions by physicians and nurses that escalated and increasingly distressed patients already critically distressed.  In a comment on the Bipolar Advantage post, I summarized the desires of commenters in designing a helpful environment:

  Essential needs:

Dignity protected
Respectful
Family/significant supporters’ unrestricted presence
Advocate present
Comforting
Reassuring
Coaching
Partnering
Truthful and transparent information
Autonomy preserved
Planning for post-crisis self-management
Safe medication administration (right drug, right dose, right route,  right time, affordable, accessible, acceptable)
Tools for successful disease management and healthy living provided

Environment:

Medically therapeutic
Eliminate law enforcement/incarceration/containment aspects
Clear written rules – same as hotel room/gym/spa rules of conduct –         NOT  punitive/control/power-based

Health:

Healthful foods served appealingly: open kitchen
Privacy for rest and sleep
Ability to get sun, green space/nature and fresh air as desired
Meeting rooms and lounges for care, socialization, quiet activities (meditation/exercise/reading/contemplation) and care planning
Clean, attractive and non-odiferous patient care areas

That doesn’t look like to much to ask. In fact, it looks like the run of the mill hospital quality standards for every other service except psychiatry.

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