having been at so many different hospitals, both adolescent and adult, i think i can say i have a pretty good idea at a range of the care you can receive at these hospitals. a lot of my stays were for either suicidal ideation or suicide attempts, so my experiences may differ from people who went in for other experiences (hallucinations/delusions/psychosis, homicidal ideation, etc.)

the big issue that i take with the psychiatric institution, every hospital is incredibly different. while the fundamental experience might’ve been incredibly similar with things like meals and snacks at a set time, meds at set times, etc. a lot of the finer details varied.

some hospitals i went to didnt give you a choice for meals unless you were vegetarian (no vegan option available at all), other hospitals gave you a sheet to pick which meals you’d want. some hospitals didn’t allow patients to be in their room during the day, other hospitals allowed us to free roam the unit. some hospitals had activities available on request, other hospitals had activities scheduled per day. some hospitals filled the day with group therapy and other therapeutic activities, other hospitals gave us no guidance at all.

this difference didnt apply to only the schedule and rules, but also the staff on units. the staff could be wildly different at the same hospital depending on the shift. rules being enforced depended on the staff enforcing them (some were much stricter than others), and you often had to press to see how much you could get away with.

punishments also varied, mostly on the severity of actions however i have had some hospitals use collective punishments for the actions of one patient. a hospital i went to strip searched an entire unit of adolescent girls because they caught one with contraband, this same hospital collectively withheld our snack because one person stole a sharpie from the art cart that had visited our unit.

many patients can be antagonistic at hospitals like this. i’ve witnessed countless fights, both between patients and between staff and patients. i’ve seen people get thrown to the floor and pinned down, get given “booty juice” (sedative shots) to calm down, get sent to the “quiet room” (a plain room, sometimes padded). a lot of punishments i saw didnt feel equal to the crime so to speak, they felt either completely unrelated or way over the top.

i have even faced punishments for actions i did not do. my first day at a new hospital, i had gotten to the unit a total of 20 minutes ago when we had to evacuate because a pipe burst. we sat in the courtyard and i was talking with the people on my unit and trying to be friendly. on our way back upstairs, a staff i had not met yet started screaming at me for “flipping another staff member off”. being in a hospital for a suicide attempt and also triggered at this ladies immediate aggression to me, i cursed her out and screamed back at her. i was sent to my room, where i had to listen to the same staff member berate and make an example of me to the rest of the unit before coming into my room and demanding an apology. this same staff member later in my stay tried to insist that we were friends despite “starting out rough”. this staff member acted exactly like my abusive step father.

another major difference in hospitals are rooms. some hospitals are so full that every room has two patients in it, as well as the quiet room having a cot and a patient in it. some hospitals have furniture thats bolted to the ground, some gave us plastic chairs on request, some had rules saying we had to make our bed before we left our room. lots of places let us hang up pictures or art we made. the doors were different at a lot of them, many had slanted tops and no handles. one hospital i stayed at had a camera in the corner of every room that could see into the open bathroom, including the shower and toilet that had no door or curtain.

privacy was a privilege and not a right at these places. in some hospitals, i had to have a staff member fully in the bathroom with me at all times. some staff would give me the courtesy of leaving the door cracked and waiting outside, but that varied by staff. sometimes they would do random room checks where they would go through hiding spots and our personal items to check for contraband.

many situations were not handled correctly at all in hospitals.

at one hospital, i had tied a noose out of my sheet and was tightening it around my neck when a staff member came into my room. he didnt say a word about it and i ended up telling another staff later. the correct procedure to be followed was to put me on a “one to one” where i would have a single staff an arms reach from me at all times. instead, the put me on an arms reach rule, where i had to be arms reach from any staff at any given time because there was another patient who needed to be on a “one to one”. they ended up giving the both of us one staff to watch us and even moved our rooms to make us roommates.

this same hospital, i was prescribed lexapro and nearly immediately began getting incredibly sick. i couldnt hold down any food or liquid. i had told the staff previously that i had an eating disorder, so when they decided my “stomach bug” had gone on long enough anything that i did after was attention seeking. the staff went as far to call my parents and tell them i was faking this for attention. i begged staff to take me to the emergency room because i certain i would die if i kept throwing up, and i was told that the ER wouldnt help me. i was discharged and still taking lexapro, to which the psychiatrist i saw outside of the hospital immediately stopped use of. i stopped getting sick. i lost 20 pounds in a month, going from 100 pounds (already underweight) to 80 (dangerously underweight). i also went to the ER where i was told that my potassium levels were so low that i was in danger of my heart stopping.

another hospital i went in for acute suicidal ideation. i was prescribed zoloft, which made my suicidal symptoms worse. i went to this hospital three separate times within the span of 9 months where they just kept increasing the dose of zoloft. it got to the point where i was taking 150-200mg of zoloft every morning and simply getting high from it. the doctor i was assigned never thought to try something else and just kept increasing the dose. when i was discharged and began seeing a psych elsewhere, they immediately took me off the incredibly high dose and tried something new.

another hospital i went to labeled me as “aggressive” for being upset that i had been forcibly hospitalized and subsequently made homeless. i had no insurance or place to go after my hospitalization, and my fear and anger at my situation made doctors say they “wouldn’t help me if i was going to be angry”. this hospital ended up using a grant to pay for my stay and released me to a family care home where i was subjected to more abuse and trauma.

psychiatric hospitals are so vastly different from others, and even vary widely depending on the staff on a shift. this fact alone makes fixing the psychiatric system incredibly difficult because you can’t fix every hospital individually. staff are often overworked and underpaid for the jobs they do, doctors often work at several hospitals in the area and have to drive to each of them in a single day. many doctors diagnose you/prescribe meds after 15 minutes of conversation, many doctors didnt know what more stigmatized disorders were (i knew someone who had to explain what DID was to the doctor they were assigned). you dont get personalized care, you are put into a system where one size is assumed to fit all.

people who say that psych crits are ableist are viewing things as all good or all bad, but there is a lot of grey when it comes to hospitals. for a lot of people i met, the hospital was the safest place for them to be. i had met a girl who was “beyond medical necessity” and had been transferred from hospital to hospital for 8 months because she had nowhere else to go. another girl i met began acting out when she was set to get discharged because going home meant going back to abuse from her family. several people with homicidal ideation described facing severe abuse from their family, which caused their homicidal ideation. while a hospital isn’t the ideal place to be and there are a lot of problems, the solution isnt “get rid of all psych wards forever!”

i dont know how to fix the system as it stands, but i think the only first step we can take is making a universal standard for care. paying staff more, hiring more staff, and making sure staff are trained properly is not a bad idea as well. so many of the problems i faced in hospitals were an issue of staff wielding unnecessary power over me and refusing to treat me as a human deserving of respect. for a lot of people, especially adolescents in psychiatric institutions, the hospital is safer than home. instead of destroying something that already helps people, we need to fix the system so it causes less harm and helps more people better.