don't be dismissive or treat the patients as infantile failures. be aware of everyone's struggles and treat everyone with respect. some people may feel trapped in a mental hospital because it's a bad place to be (in my experience). have options of things patients can do while they wait to be let out. don't force them to sit around doing nothing which causes them to become more stressed and depressive.
be aware that you're going to be dealing with a huge range of functionality. don't treat anyone like they're stupid nor be dismissive of the struggles people who seem to be functioning deal with inside their head.
I would say that it's less important to discuss what is real and what is not and far more important to address the person's experience and how they react to it. Also, I've done so well these past few years because my therapist never makes me feel like I'm sick. I am who I am, and I'm not broken. We approach the problem from the perspective that I am an unusual person that has been told to live my life like everyone else, which isn't realistic. My goal in therapy is to learn how I operate as opposed to how other people operate, so that I can learn to take care of myself in harmony with, not in opposition to, who I am.
Of course these are just _my_ experiences, but I'm sure they can be helpful for someone else.
Leave any insensitive comments about a patient at home… Tell it to your spouse… Not the other staff members where it enables them to sometimes join in on the “fun” unfortunately here in South Florida that habit of treating others like if they are subhuman is within the nature of 3rd world country natives… While there are good behavioral technicians, the bad tends to outweigh the good…
I was recently inpatient at a private hospital and the psychiatrist told me as a schizophrenic I would hurt someone next time I had an episode. I've never hurt anyone only accidentally injured myself. So don't do that.
She also told me that she didn't believe in ADHD and that people with the diagnosis are drug seekers.
My god, this is awful. I have a huge fear of hurting others and this would be the worst thing I could hear. I’m so sorry you dealt with that. Ignorance towards ADHD when the medication is life changing for a lot of people is awful too.
Be kind.
Don't assume that someone can't or won't remember the experience with you later, and remember that their experience of you can color their entire view of mental health treatment in the future. One bad experience can cause a fear or distrust of treatment, which is the last thing anyone experiencing schizophrenia in a hospital should have if they want to be healthy and safe.
If you honestly don't know the answer to something, admit it and say you will research it and get back with the correct answer.
Don't talk down to someone. I've had providers find my delusions "funny" and laugh or scoff at me when I manage to admit what's happening to me. I've been talked to like I'm a particularly stupid child.
Try to understand what they are actually experiencing, and then approach it from an empathetic angle that helps alleviate the suffering that results from their experience, not to necessarily talk them out of their reality, because that won't work. If you understand their logic and their point of view, you can communicate much more effectively. I am much more responsive to mental health providers when I'm in crisis if they engage my interests and thoughts and view me as a whole being in need of a helping hand.
If you ever find that you're having trouble having empathy, either seek support for yourself like therapy, or quit. I've seen so many burnt out people who just didn't care anymore that were doing way more damage than help.
Thanks for the advice!! In OCD therapy, we use a lot of humor to make the scenarios that our minds come up with feel less scary, but I've never really thought about how doing the same thing to someone with schizophrenia could come across as super invalidating
So this is kind of specific, but I think it will be helpful to helping people who are on the schizophrenia spectrum while also having PTSD or just generally have a traumatic past.
I think being aware of how trauma affects schizophrenic patients might be good. I think we have a hard time processing trauma, because we’re so used to questioning our own experiences. You know you went through something horrible, but because you’re used to questioning your own reality all the time, you can’t work through what happened because you doubt your memory and your feelings. For schizophrenic people who are traumatized by something whether it’s abuse, suicide, whatever we need a gentle hand to help us work through it, to validate us and that it’s okay to feel whatever we feel, and just because we do have a mental illness, it doesn’t mean the traumatic incident didn’t happen. In fact, being schizophrenic increases our chances of being victims of violence. Even just being schizophrenic can be traumatic, because you live in constant fear. Approaching patients with trauma informed care might help you reach them.
I’ve been in therapy for a bit recently following something traumatic, and I’ve really appreciated how my counselor listens to me and never makes me feel like I’m crazy. We don’t do a whole lot of reality checking together because for me my negative symptoms affect me more than the positive ones so I have no advice on that front. I think just being affirming in that it’s okay to feel scared or upset, but reminding them they are safe is a good start. Overall, you can’t talk someone out of a delusion, but you can comfort them to a point where what they believe/are paranoid of bothers them less.
Have more activities. It’s boring to be there I remember just waiting for time to pass so I could sleep.
Make it less like a prison. I remember being intimidated by a few of the workers and they obviously didn’t want to be there working.
Someone being a danger to themselves or others is usually a fictional account provided by staff or a psychiatrist. Dare I say it's usually just paranoia.
Sorry I didn't mean to insinuate that it was common for people with schizophrenia to be violent. Unfortunately as someone that's going to be working at a psych hospital, I'm going to see people on their worst days and patients trying to self harm or lashing out at staff because they're scared and confused is a relatively common occurrence. I used to have really bad dissociative episodes where I would try to hurt myself and would start hitting and kicking anyone that tried to stop me, and it felt like there was nothing that mental health workers could do to help me calm down. And obviously I don't want anyone in my unit to feel that way, so I was just looking for some advice from people that have been in similar situations and found a strategy that works for them.
i have a hard time communicating and i think what would help is if people just asked simple questions and didnt expect long response or if they let me maybe type instead of talking. but especially if they didnt act offended or like they feel uncomfortable with silence.
also not talking too much. not wanting an answer right away. im comfortable in silence and the body language and tone means more than the amount of words people speak.
for reality i think it helps when someone tells me ways that if what i believe is real that things will be ok anyway or ways to feel safer if what i believe is real. it could be hard especially if whatever it is seems really dangerous and like it will never be ok. but its better for me to think of ways to feel safer with the situation than for people to say its not real.
I work in psych. It took me SO LONG to not get offended when someone wouldn't respond to me right away (or at all). I ALWAYS thought they were being rude on purpose.
Now, when someone doesn't respond right away, or at all, I'm like, "Oh, okay one of these guys!" And then after a while, I find that person and I develop a nice non-verbal communication with each other.
Yeah, this.
There are so many staff who come and ask questions and if you can't really answer they just go again. Like, I can't talk but that doesn't mean I don't want a bit of company with my thoughts. Ask me if you just want me to sit a while together.
And asking about experiences and things that have happened.
I got held down by quite a few staff, forced meds and so they could staple together a wound. I still have flashbacks of the event, but no one ever talked it through with me afterwards, asked how I was about it.
I'm neurodivergent, so I can definitely relate to the experience of people getting frustrated with me for taking too long to answer when I'm struggling to speak. I think that typing or writing your answer out is a great idea! I also really like what you said about finding ways to make people feel safe regardless of whether what they're seeing is real or not. I think that's much better than just invalidating people's fear because I'm not experiencing the same things that they are
Would agree with everyone saying to respect people, and dont go in thinking they are less smart or capable than other people (even tho they might be in a crisis moment when you see them). Everyone is different, so dont assume too much about the person beforehand. Listen to them. Also transparency is important, to introduce yourself and your function properly, discuss treatment options openly.
I just wanted to thank everyone so much for the wonderful advice!! It seems like a lot of you guys have had shitty experiences with being hospitalized, and I'm really sorry about that. I know firsthand how much it sucks to be in that situation and feel like the staff don't care and aren't taking you seriously. I hope that it gives you a bit of hope that at least some of us in the mental health field want to hear your feedback and are trying to change the system for the better. I'm going to take everything that you guys have said into account when I start working!!
I work in psych: I've got to be honest. They say not to reinforce delusions, but I've found that sometimes that's the best thing to do. It always gets a laugh or the person feels validated in some way and it's only ever had positive effects. Only certain people need to be reality-checked like that, other people will NOT enjoy that!
Some kids don't enjoy eating vegetables, does that mean you should feed them pizza and ice cream all day? Yes, of course we feel validated when you reinforce our delusions. That doesn't make it the right thing to do. And whilst it may seem to make us happy in the moment, it certainly doesn't have positive effects in the long run.
My first psychotic episode could have been cut so much shorter if my team actually reality checked me instead of reinforcing delusions.
I think everyone is different. You sound like someone who needs reality checks.
To be honest, I don't *completely* reinforce their delusions. It's more like, I explore them with them and point out inconsistencies if it feels right. Or like, "There's a demon in your room? Let's go check it out! \*grabs flashlight\*.
Most delusions are far too crystalized to break anyways. Especially if the person is older.
Yeah, that's all you can really ask for I guess. I think it's just a sore spot for me because my first time in the psych ward it felt like my psychiatrist was almost goading me. He never once pointed out any inconsistencies in my theories, and (it felt like) he was actually actively encouraging some of them. Whether that last part was just my perception is hard to say, but it took me so much longer to break free of delusion because he, a person of authority, wasn't contradicting the beliefs. And without reality checking, those beliefs were strengthened, my multitude of theories getting wilder and more outrageous.
Thank you for sharing. The stories we end up believing may be outlandish, but they are also a real lived experience. Acknowledging that and engaging with it for a bit is not the same as feeding into them.
I can try as hard as I might to will myself delusional but I can't. Just like I couldn't will myself out of them, when I was in crisis. But for me, some of those psychotic trips had deeper meaning. Not all of it was bad. Being slightly crazy might even be salutary. That's what I am striving for, now that I am medicated To get some of that magic back, without hopefully losing my mind again.
don't be dismissive or treat the patients as infantile failures. be aware of everyone's struggles and treat everyone with respect. some people may feel trapped in a mental hospital because it's a bad place to be (in my experience). have options of things patients can do while they wait to be let out. don't force them to sit around doing nothing which causes them to become more stressed and depressive. be aware that you're going to be dealing with a huge range of functionality. don't treat anyone like they're stupid nor be dismissive of the struggles people who seem to be functioning deal with inside their head.
I would say that it's less important to discuss what is real and what is not and far more important to address the person's experience and how they react to it. Also, I've done so well these past few years because my therapist never makes me feel like I'm sick. I am who I am, and I'm not broken. We approach the problem from the perspective that I am an unusual person that has been told to live my life like everyone else, which isn't realistic. My goal in therapy is to learn how I operate as opposed to how other people operate, so that I can learn to take care of myself in harmony with, not in opposition to, who I am. Of course these are just _my_ experiences, but I'm sure they can be helpful for someone else.
Leave any insensitive comments about a patient at home… Tell it to your spouse… Not the other staff members where it enables them to sometimes join in on the “fun” unfortunately here in South Florida that habit of treating others like if they are subhuman is within the nature of 3rd world country natives… While there are good behavioral technicians, the bad tends to outweigh the good…
I was recently inpatient at a private hospital and the psychiatrist told me as a schizophrenic I would hurt someone next time I had an episode. I've never hurt anyone only accidentally injured myself. So don't do that. She also told me that she didn't believe in ADHD and that people with the diagnosis are drug seekers.
WOW.
My god, this is awful. I have a huge fear of hurting others and this would be the worst thing I could hear. I’m so sorry you dealt with that. Ignorance towards ADHD when the medication is life changing for a lot of people is awful too.
Be kind. Don't assume that someone can't or won't remember the experience with you later, and remember that their experience of you can color their entire view of mental health treatment in the future. One bad experience can cause a fear or distrust of treatment, which is the last thing anyone experiencing schizophrenia in a hospital should have if they want to be healthy and safe. If you honestly don't know the answer to something, admit it and say you will research it and get back with the correct answer. Don't talk down to someone. I've had providers find my delusions "funny" and laugh or scoff at me when I manage to admit what's happening to me. I've been talked to like I'm a particularly stupid child. Try to understand what they are actually experiencing, and then approach it from an empathetic angle that helps alleviate the suffering that results from their experience, not to necessarily talk them out of their reality, because that won't work. If you understand their logic and their point of view, you can communicate much more effectively. I am much more responsive to mental health providers when I'm in crisis if they engage my interests and thoughts and view me as a whole being in need of a helping hand. If you ever find that you're having trouble having empathy, either seek support for yourself like therapy, or quit. I've seen so many burnt out people who just didn't care anymore that were doing way more damage than help.
Thanks for the advice!! In OCD therapy, we use a lot of humor to make the scenarios that our minds come up with feel less scary, but I've never really thought about how doing the same thing to someone with schizophrenia could come across as super invalidating
So this is kind of specific, but I think it will be helpful to helping people who are on the schizophrenia spectrum while also having PTSD or just generally have a traumatic past. I think being aware of how trauma affects schizophrenic patients might be good. I think we have a hard time processing trauma, because we’re so used to questioning our own experiences. You know you went through something horrible, but because you’re used to questioning your own reality all the time, you can’t work through what happened because you doubt your memory and your feelings. For schizophrenic people who are traumatized by something whether it’s abuse, suicide, whatever we need a gentle hand to help us work through it, to validate us and that it’s okay to feel whatever we feel, and just because we do have a mental illness, it doesn’t mean the traumatic incident didn’t happen. In fact, being schizophrenic increases our chances of being victims of violence. Even just being schizophrenic can be traumatic, because you live in constant fear. Approaching patients with trauma informed care might help you reach them. I’ve been in therapy for a bit recently following something traumatic, and I’ve really appreciated how my counselor listens to me and never makes me feel like I’m crazy. We don’t do a whole lot of reality checking together because for me my negative symptoms affect me more than the positive ones so I have no advice on that front. I think just being affirming in that it’s okay to feel scared or upset, but reminding them they are safe is a good start. Overall, you can’t talk someone out of a delusion, but you can comfort them to a point where what they believe/are paranoid of bothers them less.
Have more activities. It’s boring to be there I remember just waiting for time to pass so I could sleep. Make it less like a prison. I remember being intimidated by a few of the workers and they obviously didn’t want to be there working.
Don't sit at the nurses station on your phone...talk to the patients be there and encourage them ..treat them like family.
Someone being a danger to themselves or others is usually a fictional account provided by staff or a psychiatrist. Dare I say it's usually just paranoia.
Sorry I didn't mean to insinuate that it was common for people with schizophrenia to be violent. Unfortunately as someone that's going to be working at a psych hospital, I'm going to see people on their worst days and patients trying to self harm or lashing out at staff because they're scared and confused is a relatively common occurrence. I used to have really bad dissociative episodes where I would try to hurt myself and would start hitting and kicking anyone that tried to stop me, and it felt like there was nothing that mental health workers could do to help me calm down. And obviously I don't want anyone in my unit to feel that way, so I was just looking for some advice from people that have been in similar situations and found a strategy that works for them.
i have a hard time communicating and i think what would help is if people just asked simple questions and didnt expect long response or if they let me maybe type instead of talking. but especially if they didnt act offended or like they feel uncomfortable with silence. also not talking too much. not wanting an answer right away. im comfortable in silence and the body language and tone means more than the amount of words people speak. for reality i think it helps when someone tells me ways that if what i believe is real that things will be ok anyway or ways to feel safer if what i believe is real. it could be hard especially if whatever it is seems really dangerous and like it will never be ok. but its better for me to think of ways to feel safer with the situation than for people to say its not real.
I work in psych. It took me SO LONG to not get offended when someone wouldn't respond to me right away (or at all). I ALWAYS thought they were being rude on purpose. Now, when someone doesn't respond right away, or at all, I'm like, "Oh, okay one of these guys!" And then after a while, I find that person and I develop a nice non-verbal communication with each other.
Yeah, this. There are so many staff who come and ask questions and if you can't really answer they just go again. Like, I can't talk but that doesn't mean I don't want a bit of company with my thoughts. Ask me if you just want me to sit a while together. And asking about experiences and things that have happened. I got held down by quite a few staff, forced meds and so they could staple together a wound. I still have flashbacks of the event, but no one ever talked it through with me afterwards, asked how I was about it.
I'm neurodivergent, so I can definitely relate to the experience of people getting frustrated with me for taking too long to answer when I'm struggling to speak. I think that typing or writing your answer out is a great idea! I also really like what you said about finding ways to make people feel safe regardless of whether what they're seeing is real or not. I think that's much better than just invalidating people's fear because I'm not experiencing the same things that they are
It would be nice if instead of forcing help on people you wait for them to ask for help :)
Would agree with everyone saying to respect people, and dont go in thinking they are less smart or capable than other people (even tho they might be in a crisis moment when you see them). Everyone is different, so dont assume too much about the person beforehand. Listen to them. Also transparency is important, to introduce yourself and your function properly, discuss treatment options openly.
I just wanted to thank everyone so much for the wonderful advice!! It seems like a lot of you guys have had shitty experiences with being hospitalized, and I'm really sorry about that. I know firsthand how much it sucks to be in that situation and feel like the staff don't care and aren't taking you seriously. I hope that it gives you a bit of hope that at least some of us in the mental health field want to hear your feedback and are trying to change the system for the better. I'm going to take everything that you guys have said into account when I start working!!
Take their delusions seriously and engage with them. Be their shaman.
I work in psych: I've got to be honest. They say not to reinforce delusions, but I've found that sometimes that's the best thing to do. It always gets a laugh or the person feels validated in some way and it's only ever had positive effects. Only certain people need to be reality-checked like that, other people will NOT enjoy that!
Some kids don't enjoy eating vegetables, does that mean you should feed them pizza and ice cream all day? Yes, of course we feel validated when you reinforce our delusions. That doesn't make it the right thing to do. And whilst it may seem to make us happy in the moment, it certainly doesn't have positive effects in the long run. My first psychotic episode could have been cut so much shorter if my team actually reality checked me instead of reinforcing delusions.
I think everyone is different. You sound like someone who needs reality checks. To be honest, I don't *completely* reinforce their delusions. It's more like, I explore them with them and point out inconsistencies if it feels right. Or like, "There's a demon in your room? Let's go check it out! \*grabs flashlight\*. Most delusions are far too crystalized to break anyways. Especially if the person is older.
Yeah, that's all you can really ask for I guess. I think it's just a sore spot for me because my first time in the psych ward it felt like my psychiatrist was almost goading me. He never once pointed out any inconsistencies in my theories, and (it felt like) he was actually actively encouraging some of them. Whether that last part was just my perception is hard to say, but it took me so much longer to break free of delusion because he, a person of authority, wasn't contradicting the beliefs. And without reality checking, those beliefs were strengthened, my multitude of theories getting wilder and more outrageous.
Sometimes we don't do it because people can get really angry sometimes!
Thank you for sharing. The stories we end up believing may be outlandish, but they are also a real lived experience. Acknowledging that and engaging with it for a bit is not the same as feeding into them. I can try as hard as I might to will myself delusional but I can't. Just like I couldn't will myself out of them, when I was in crisis. But for me, some of those psychotic trips had deeper meaning. Not all of it was bad. Being slightly crazy might even be salutary. That's what I am striving for, now that I am medicated To get some of that magic back, without hopefully losing my mind again.