Are Mental Hospitals Good for Mental Health?

Source: Unsplash/Martha Dominguez de Gouveia

I was going over action plans in case of an emergency with my new psychiatrist that I found after moving to New York City. We were discussing what I should do in case I were to have suicidal ideas.

She told me, “I think you should go to the emergency room, because you will be the safest there.”

I paused after she said that. I didn’t go into the long speech I had in my head. I didn’t tell her that I actually promised myself I would never check myself into a psychiatric hospital ever again since the last time I was hospitalized I was met with discrimination and a worse outlook on my ability to recover fully from schizoaffective disorder.

I protested for a second, then she pushed back. I outwardly told her I would do as she said to appease her sense of guidance, although I walked away from the appointment knowing full well that I was going to simply lie in bed with the lights shut off and call a loved one if I ever got suicidal urges again.

This moment struck me as an important one, because often there is a sense of disagreement over what should be done with those of us who are ridden with raging psychiatric symptoms like mania, suicidal ideation, psychosis, and more. The perception within the mental health community sees people with severe psychiatric episodes as people without agency, and one of the first things physicians expect patients to do is to put themselves into a psychiatric hospital.

Psychiatric hospitals vary by location, price, and quality. We’ve come a long way from the portrayals we’ve seen in movies like One Flew Over the Cuckoo’s Nest and Girl, Interrupted, both regarded at their time as defining movies about the American mental health industry, but often it is notoriously known that patients despise mental hospitals.

Most cities have a local state hospital that can house psychiatric patients by default if the patient doesn’t have a preference. Some of the state hospitals are viewed by patients as a last resort, considering much of the time patients have limited privacy and space, often without doors on bathrooms or knobs on sinks with a strict dress code of hospital smocks.

What is considered natural in the “normal” world becomes a privilege that is threatened to be taken away the minute a patient present with a violent symptom. I remember I stayed in one hospital where the lightbulb to the refrigerator was taken out because someone in the past had tried to eat it to kill himself. Such drastic behaviors thus ensure drastic responses that become rules in the hospital.

Additionally, staffers at these hospitals may not have extensive training, as the state may require very little training before getting hired on as a nurse or attendant. However, psychiatric nursing is an RN specialty only granted after serious study and shadowing.

Meanwhile, there exist higher-end privately-owned hospitals that cater to a demographic able and willing to pay more for more courteous treatment. There can be many private hospitals in every state. Some higher-end hospitals on offer the option of bringing a pet with the patient as well as a suitcase of clothes (at state hospitals, often a person cannot bring their own clothes), and a selection of wholesome, organic fruits and vegetables. Celebrities may choose these hospitals because they are more private and exclusive.

Both types of facilities only offer acute treatment periods. Long gone are the days when “mental institutions” existed only to house truly severe and nonfunctioning people with psychiatric illnesses.

The environment of a mental hospital affects clinical outcomes, according to researchers involved in a study published in Psychological Medicine in 2022. Satisfied patients have better recovery outcomes. But surprisingly little research has been done to investigate which elements of a hospital actually help those seeking psychiatric treatment during an overnight stay. While physicians like to boast about how hospitals lead to suicide prevention, many patients are left dissatisfied or traumatized by their treatment there, which can include staffers strapping flagrantly psychotic people down and injecting them with sedatives.

So what hospital elements do help patients recover? Researchers studied 18 psychiatric hospitals in Italy and the United Kingdom with 2130 patients, evaluating hospital features that are typically exclusive only to psychiatric units, like segregated-sex spaces and limited access to sharp objects that could be used to hurt oneself or others.

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The study found that two main features that affected the satisfaction of patients were the options of having rooms to meet their visiting family off the ward and mixing the sexes of the hospital units. Surprisingly, both of these factors affected women more than men in the patient survey responses, despite previous literature suggesting that hospitals were built in a segregated way to prevent sexual harassment and assault.

Italian hospitals contained wards that were mixed-sex simply because their psychiatric units are built within the same site as a regular hospital instead of off-site in an entirely different facility, as is typical in the U.S. and the UK. The authors caution that psychiatric issues may not fully be cared for with just that implementation alone, as patient satisfaction can vary by age, illness stage, and interaction with staff.

While this study is the largest to date of its kind, there is limited research in the United States and the rest of the world about what exactly makes a psychiatric hospital conducive for both a patient’s physical safety and internal satisfaction.

It is not a mystery why there is a significant lack of trust between patients and their physicians, and vice versa. While much of the industry continues to maintain historical prejudices and stereotypes, the best treatment we have to offer for psychiatric patients seems to be based on guesses alone. What can we do to ensure treatment that maintains a patient's dignity but also remains effective? The answers seem to only exist in future scientific investigation.

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.