Restoring dignity: A teenager’s insights into inpatient psychiatric admission

Editor’s note: Healthy Debate has agreed not to publish the name of this author over concerns the diagnosis of bipolar disorder will affect future academic endeavours.

My family was no longer my family. In my state, they seemed to be empty shells of people controlled by men with an agenda – to torture me. After I had mustered the courage to give a friend permission to tell my parents, I ended up in a hospital emergency room. Except to me the hospital was not an ordinary hospital. There were cameras everywhere, just watching me suffer. They were watching me during the eight-hour wait to see the emergency doctor, and they were there for the additional four-hour wait to see the psychiatry team.

I am confident that if I was not with my mother at this time, I would have left the tormenting emergency room behind and embarked on a quest to find the men controlling the people around me. I had no impulse control, no safety awareness and a deteriorating sense of reality.

I am no expert in emergency triage, but what I know is that my family had to beg for a doctor to see me because I was repeatedly moved down the priority list. During the initial eight-hour wait, there was zero communication by any health-care provider. I may not have had bleeding in my brain, but I felt like my brain was on fire.

There were no beds left for me on the psychiatry ward, and my symptoms subsided enough for me to be sent home. One week later, I was back in the same emergency room with hallucinations, racing thoughts, grandiose ideas and a decreased need for sleep. This was when I was first diagnosed with bipolar disorder, and I spent the next few weeks receiving inpatient treatment for the acute manic episode.

As a 19-year-old Health Sciences student with a new patient perspective, I’m sharing my observations in the hope of stimulating discussion and advocating for young people experiencing acute mental health crises.

Anyone suffering an acute mental health crisis needs to know that there will be people in the emergency room who care and recognize the difficulty of waiting in such a high level of distress. No one should have to wait eight hours to have an initial assessment, and if so, there should be communication along the way by health-care providers. There’s growing evidence that peer-support services in the emergency room aid young adults experiencing difficulties with mental illness. Peer support involves having people available who have lived experience with mental illness, but are further along in their recovery, to offer support to patients in need.

I may not have had bleeding in my brain, but I felt like my brain was on fire.

Putting up to four people in an acute psychiatric crisis in the same room to sleep may be cost effective but is detrimental to patient well-being. During one of my first nights in the ward, I entered my room to find numerous nurses and security guards trying to medicate my roommate while she was held down after previously assaulting the nurses. In my heightened state of anxiety, I thought that if I slept next to her, I would be strangled in my sleep. After begging the nurses for new accommodations, I ended up in the only available space to sleep, the isolation room. It’s the only room in the psychiatric ward that sleeps one person because it’s meant for someone with an infectious disease. No other patient is worthy of privacy on the ward, I guess. Subsequent nights were spent next to a roommate vomiting in opioid withdrawal, and across from someone sleep-screaming due to hallucinations. During this admission I needed a brain rest, but the overwhelming external stimulation made it difficult to follow my course of treatment.

At 19, I was too old for the adolescent ward but not feeling quite ready for the adult ward. Nothing magical happens on your 18th birthday; people in their late teens and early adulthood greatly benefit from the family involvement that’s included on the adolescent ward, but less so on the adult ward. Especially when it comes to bipolar disorder, it’s usually the family’s role to pick up on early symptoms of mania or depression, which is why it’s crucial there’s an option to involve family in young adult care.

My experience is not in a vacuum. In Canada, 2.4 per cent of people live with bipolar disorder, and many of them require hospitalizations. Bipolar disorder typically presents itself in people’s late teens or early 20s, which stresses the need for specialized young adult inpatient resources.

Now, I have withdrawn from my semester of university, and what I lack in traditional education I have gained in first-hand experience. I have learned about the gaps in acute psychiatric inpatient care, which I hope to somehow improve in the future. I am learning how to take on a new lifelong illness in stride, knowing that the illness will present its challenges, but that I have the potential to live a fulfilling life. This I cannot undertake on my own; it will take a supportive team of nurses, psychiatrists, friends and family to give me the tools to live with bipolar disorder.

I have learned how to be empathetic to others around me. Both people in conflict with the law and the under-housed were my roommates, and they are just as human as me.

It would be impactful if everyone could spend time on the psychiatry ward as an observer because mental illness is a great equalizer – the wealthy and the impoverished live under the same roof, eat the same crappy food and take the same “wellness walks” every morning.

What seem like obvious changes to inpatient psychiatric care, like private rooms, young adult cohorts, peer support during admission and timely assessments could help restore dignity for those going through a mental health crisis.