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Working at a Psychiatric Hospital: The Good, The Bad, and the Ugly

I have been a mental health professional for over 20 years. I provide case management services for people with developmental disabilities.

What is it like working at a psychiatric hospital? Read on to find out.

What is it like working at a psychiatric hospital? Read on to find out.

What Is It Like to Work at a Psychiatric Hospital?

It took me a year to find a job after graduating from college, so I jumped at the opportunity to work at a local psychiatric hospital. The pay wasn't great, but I saw it as an opportunity to gain some experience in my field of study.

In this article, I'll cover:

  • The basic duties performed by employees at a psychiatric hospital
  • The different units of a psychiatric hospital
  • What it's like to work the night shift
  • The good, the bad, and the ugly of working at a psychiatric hospital

Basic Duties of a Psychiatric Hospital Employee

My official title was mental health worker. This position is sometimes referred to as a mental health technician. It's an entry-level position but carries tremendous responsibilities and potential liability.

  1. Assisting with admissions: Part of my job was to assist patients with the admissions process. This included checking baggage and the patient for any dangerous objects that could be used to harm themselves or others.
  2. Checking vital signs: I checked the patients' blood pressure and temperature. This was usually done at admission and in the mornings. Patients in the substance use recovery unit were monitored every two hours.
  3. Monitoring: Mental health technicians monitor patients for safety. Rounds were usually conducted every 15 minutes. Patients on suicide watch or close watch often required a separate form of documentation to verify that they were monitored for safety. It was extremely important to monitor at night. In some cases, you'd have to change your pattern. Patients that were highly suicidal would try to time your bed check and then harm themselves between rounds.
  4. Crisis intervention: Everyone admitted into the psychiatric hospital was in some form of crisis or mental distress. Some were in a mild state of depression, some were self-admitted to the substance abuse treatment unit, while others were admitted because they were a danger to themselves or others.

Crisis Intervention Techniques

Crisis intervention includes using verbal techniques to prevent a situation from getting worse. Sometimes verbal intervention is unsuccessful and physical intervention is needed.

Mental health workers and nurses are trained in using physical techniques to safely prevent someone from harming themselves or others. Two of the most utilized programs that I know of are Therapeutic Options and MANDT.

Typical time-out room in a psychiatric hospital

Typical time-out room in a psychiatric hospital

Psychiatric Hospital Units

Psychiatric hospitals have several units, which vary depending on patient needs and reason for admission.

Therapeutic Unit

Most of the patients in this unit admitted themselves to the hospital due to depression. These patients were usually not psychotic and did not present a significant danger to others.

They still needed to be monitored for safety. This usually consisted of 30-minute checks during the day and 15-minute checks at night. There were usually support groups facilitated by licensed clinicians during the day.

Substance Use Recovery Unit

Patients in the substance use recovery unit were also primarily self-admitted or admitted with family assistance. It's important to maintain a close eye on the patients due to physical withdrawal symptoms. Vital signs were taken every two hours during the day. If their blood pressure readings were too high or too low, they were transported (by ambulance) to the nearest hospital.

Hospitals also need to be careful because some patients in this unit are HIV-positive due to drug use. Hospitals usually have an internal code or sign to indicate the patient's status. This is for employee safety, and this indicator is never exposed to the public.

Working in the recovery unit was a good experience, but watching people go through withdrawal was also difficult. The worst withdrawal I have ever witnessed was a young man going through detox from cocaine, heroin, and alcohol. People shake, moan in pain, and sometimes lose control of their bodily functions. It was definitely an eye-opening experience.

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Locked Unit

This unit was primarily for involuntary admission to the hospital. These patients were often experiencing psychotic symptoms due to not taking their medications. They also presented suicidal or homicidal behaviors. They were screened by a trained clinician and determined to be a danger to themselves and/or others. This is referred to as a temporary detention order or TDO.

TDO patients were required to remain in the hospital for 72 hours before they went before a judge. The judge then determined if the patient was stabilized or needed time for more treatment.

I spent most of my time on this unit. This was primarily because I’m a male. Just about every shift, there was someone who needed to be restrained, and they preferred to have more males in that unit.

The physical restraining of people and seeing them in four-point restraints on a daily basis took a toll on me. It was physically and emotionally draining. I realized that it needed to be done for safety, but seeing people strapped down on a bed never sat well with me.

Typical leg/arm restraint used in psychiatric hospitals

Typical leg/arm restraint used in psychiatric hospitals

Night Shift

I started working the night shift, and it proved to be yet another challenge. It was more of a physical adjustment for me than anything else. My primary concern with the night shift was the limited staff.

Many psychiatric hospitals staff their facilities based on census. This means that the amount of staff is based on the number of patients or the unit. In my situation, it was usually just me and a nurse on staff with a unit of 12 patients. Do you see how this could be a problem?

If there was an emergency, we could call for help from another floor. Of course, this took away from their staffing and created a domino effect. A third night staff person was usually added when the census was around 18.

Nighttime was often when many people go into crisis. One night, we had six admissions in one shift, which wore me out. These admissions could be violent, and sometimes the police were needed to help make the situation safe.

The Good, the Bad, and the Ugly of Working at a Psychiatric Hospital

There are pros and cons to this type of work. Here are the good, bad, and ugly elements of working at a psychiatric hospital.

The Good

This was my first job out of college, and it gave me an opportunity to gain valuable experience in the field of psychology. I was exposed to several treatment units and was able to learn crisis intervention skills. I was able to get a better understanding of clinical depression by working with patients directly and learning from more seasoned employees.

The Bad

One of the negative aspects of the job was the low pay. It was an entry-level position, but the pay was not enough considering the level of physical risk involved. Low pay leads to high turnover. Of course, turnover is another major problem with these types of jobs. Many feel the risk is not worth it, and they move on to higher-paying jobs.

The Ugly

The job of a mental health worker can take a major physical and emotional toll. While working at the hospital, I was bitten on the arm and had my glasses ripped off my face. I was also threatened countless times. I was never really afraid of any of the patients, but as a human, you just get tired of dealing with verbal abuse on a daily basis.

Overall, the Experience Was Worth It

In general, I believe that my experience working at the psychiatric hospital was beneficial. It taught me how to handle crisis situations in a professional manner.

I developed a thick skin for threats, insults, and abusive behaviors. I realized that it was the illness, not the person, that was actually lashing out at me. I learned not to take it personally. This is difficult because we are all human, and this kind of behavior can be difficult to ignore. This is especially difficult for a young person experiencing this for the first time.

Experience is the only way you can improve in this area because at the end of the day, you are the professional, and you have to exhibit self-control.

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2014 Martin D Gardner

Comments

drdspervez from Pakistan on March 10, 2018:

Nice article,you are right that after completing your studies you need to get a job if it is not up to your wishes then also to remain in profession you have to select a job & with passage of time you start loving your work place and the people around you.

Larry Rankin from Oklahoma on July 28, 2015:

It is essential we have people willing to work with the mentally ill.

Very informative.

jtrader on October 18, 2014:

Certainly we all can learn a lot from your experience. Developing a thick skin is essential in life. Sometimes we all encounter people who act in unacceptable ways because of factors that have nothing to do with us.

Martin D Gardner (author) from Virginia Beach on September 10, 2014:

Epbooks, It definitely takes a special person to do that on a long term basis. I realized quickly that this would be a short term experience for me.

Elizabeth Parker from Las Vegas, NV on September 10, 2014:

I can only imagine how difficult it must be to work at this type of hospital. I don't think that I could do it!

Martin D Gardner (author) from Virginia Beach on September 09, 2014:

Thanks! And thanks for sharing your experience Denise.

Denise W Anderson from Bismarck, North Dakota on September 09, 2014:

Having been a patient at a psychiatric unit, and having had family members as patients, I take my hat off to those who are able to work in these types of environments. It is not an easy place to be, either for the patient or the worker. Thanks for sharing your perspective with us!

Martin D Gardner (author) from Virginia Beach on September 08, 2014:

Thanks. The hospital I worked at was very professional. I’m sure some of the large institutions have issues with abuse. The job is definitely not for everybody. I can honestly say that people were treated with dignity and respect in this particular hospital.

Mel Carriere from Snowbound and down in Northern Colorado on September 08, 2014:

Sounds like a grueling job. I have heard horror stories from the patient perspective, and I am happy you have not reinforced them. You sound like you did your job humanely and conscientiously. Great hub.

Martin D Gardner (author) from Virginia Beach on September 08, 2014:

Thanks for stopping by Sangre and Ms. Dora. Yes my skin is as tough as leather now lol. It really takes a lot to bother me.

Dora Weithers from The Caribbean on September 08, 2014:

Now I would work in a psych hospital; I may not have said yes in my younger years. It takes a lot of compassion and understanding to do this kind of work for little pay. Very smart of you to expose yourself to this experience and thanks for sharing.

Sp Greaney from Ireland on September 08, 2014:

It sounds like a tough job to do. I think having a tough skin like you mention is not something we all can achieve.

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