The Ward

Where I work is composed of two buildings. One building contains 100% psychiatric patients. They either have a severe, usually relatively uncontrolled psychiatric diagnosis, or they have dementia with very severe behavioral issues (ie they've sent someone at a regular nursing home to the emergency room). The other building is a mixture. Many of the patients are fairly typical nursing home patients. Many were not particularly easy dementia patients but not "dangerous" patients. Some are just in from the surrounding community to recover from illness or surgery. Those people are kept fairly isolated. And then there is "the ward".

I've seen this happen twice now. A few years back reimbursement started being better if you put patients with psychiatric diagnoses in "behavioral units". I don't object to this concept per se, certain patients need a locked environment to be safe, and plenty thrive this way. What I do object to though is the collateral damage. Coincidentally both times that a facility I worked in went to this behavioral unit model I was on disability and walked back in to find one section blocked off and those residents isolated. My issue is that both times people who were not violent, who were quite capable of being part of the general life of these facilities that are dedicated to caring for people with psychiatric needs (for pete's sake, we have to have training on how to put people on the floor without hurting them.....) suddenly were restricted.

Both times there have been people who are harmless but a little "embarrassing" to the public who wind up out of sight. Both times I have been very upset about this. Supposedly our world has moved so far forward in accepting mental and physical disabilities. Just today I spoke with the mother of a very old for his condition patient with Down's syndrome. She told me what it was like to have that diagnosis many years ago and how far her son's quality of life came. Yet when I walk onto that ward, an area I have carefully avoided for the last few months because it breaks my heart, all I can do is wonder if someday I too will be shut up somewhere because of my embarassing behaviors. Please God, let this never be true. I accept that I will lose much to this illness, and that I may lose much of my cognitive function. I accept that sometimes now and always my behaviors will be inappropriate. But I value freedom so much that I believe I would want to die if locked up for a reason other than my safety.

When I began this blog I meant to write about some of what I see and feel doing what I do. This year did not go according to my plans, and so instead I'm leaving mental health as a specialty before I even start writing. (Did I mention that part? I'm changing specializations.) I hope to write about it anyway from time to time, and I'll still have new things as well. However, to be totally candid this new ward is one of the reasons I am ready to leave. I was on it today with a longtime favorite patient--she calls me "mother"--clinging to me sobbing because she was so glad to see me, knowing that this woman has no reason not to be freely wandering as happy as a clam, harming nobody, just looking and acting different because of her diagnoses. All I could think of was how wrong and how I feel like a hypocrite having anything to do with a system that sticks people just like me in a locked area so others aren't uncomfortable.

And then I thought that not feeling that way, not feeling compelled to get out of there, would mean what I fear so much: that the illness won, or that the society that judges the illness won. So I'm taking a stand in a way. Too bad nobody knows, and even sadder that those who control things couldn't care less.