The dilemma of hospitalization

“Human variations are not open to cure – only to coping.”  ― Marius Romme

The United States Community Mental Health Act of 1963 was enacted to facilitate the deinstitutionalisation of costly inpatient psychiatric facilities, integrating treatment within the local community context and into the hands of state and county-led outpatient mental health organizations. This deconstruction of inpatient treatment was attributed to the beginning of the so-called “pharmacological revolution”1, whereby psychotropic medication was prescribed in abundance to chemically lobotomise those who once lived within hospital walls.

With the increase in hyper-conservative political ideology in the second half of the 20th century came a decrease in federal support for the community mental health centers that the 1963 Community Mental Health Act relied on to aid in successful deinstitutionalization2. The ever-decreasing federal and state funding of community mental health services results in unequipped community services reliant on unequipped hospitals in order to handle individual’s who may have more complex and acute needs. 

intended Goals of hospitalization

The goals of inpatient hospitalization include3:

  • Suppressing aggression and keeping the individual physically safe
  • Supervision over experimenting with type and dosage of medication
  • Reducing anxiety (of the individual and/or their support network)
 

Inpatient hospitalization aims to address these goals utilizing the supports of4:

  • Psychiatric and medical evaluation and diagnosing
  • Psychiatric medication consultation and adjustments
  • Supportive trained staff available 24/7
  • Therapeutic support groups
  • An environment free of potentially harmful objects or structures


the psychological effects of hospitalization

Many mental health training programs do not teach outpatient providers about how to work with people who live in altered states, which results in an individual potentially having numerous hospitalizations in a short amount of time. This leads to a “revolving door syndrome“5, a continuously re-traumatizing cycle that can lead to “hospitalism”.

Hospitalization often perpetuates a state known as “hospitalism“6, where a person learns to lead a passive life without challenges. Being hospitalized not only strips one of their freedom and independence; it sends a stigmatizing and discriminatory message to the individual (and their support network) that they are ‘out-of-control’ and require outside intervention to change and grow.

 

Mad in America Podcast: Episode 38
"Jeffrey Michael Friedman, LCSW:
Trauma and Forced Psychiatric Treatment"

“This week on MIA Radio, we interview Jeffrey Michael Friedman, a clinical social worker and an activist in the psychiatric survivor’s movement … In this interview, we discuss why forced psychiatric treatment is a form of trauma and its impact on victims and their families.” (Length: 38 minutes)

Hospital Procedures to Involuntarily Hospitalize an Individual7

1.

The E.R. doctor will submit a letter called the “First Cert” verifying the individual's risk level and decision to not go to the hospital voluntarily. The individual is required to be held at the E.R. for no more than 24 hours (or until they are assessed).

2.

A psychiatrist from the Department of Mental Health (DMH) will assess them for risk of harm. This is often done via telehealth.

3.

If the DMH psychiatrist finds that they are a risk of harm to self/others and meet criteria for hospitalization, they will submit a “Second Cert” letter. The individual can no longer leave the ER unless a mental health clinician assesses them and finds they have regained the capacity to maintain safety.

4.

The mental health agency clinician will re-assess them every 24 hours while working to find a psychiatric hospital placement for them. The person can choose whether to begin or continue treatment with psychiatric medication while in the E.R.

5.

Once the mental health agency clinician finds an open bed that will accept them, the individual will be transported there via ambulance. If the individual presents as a high risk of elopement or injury to themselves or others, they will be transported by a police sheriff in their squad car.

6.

Sometimes, an Order of Non-Hospitalization (ONH) is created once an individual is discharged from the hospital. They must follow the rules listed on the ONH while in the community, and may be sent back to the hospital if they break any of the rules. An ONH is similar to parole for criminal offenders.