You wake up at the crack of dawn, a few hours earlier than you really need to.
Your bed isn’t helping - it’s small, if not completely uncomfortable, and there isn’t
much room to toss and turn.
You can hear noises around you - the staff getting ready for the day’s work - and the
sun is peeking through the curtains.
It’s looking like a lovely day outside, but you’re not likely to be spending much
time outside.
You’re in a mental hospital, and the usual day’s routine is about to begin.
You should probably get some rest while you can - life here is strictly regimented.
Your first taste of this structure comes as it’s time to get up.
At the same time every day - usually 7 AM - you’ll hear a knock at your door.
This is one of the staff doing morning checks.
They want to make sure that all the residents are okay after the night, and this is usually
accompanied by a warning that breakfast will be served in half an hour.
Mealtimes are usually carefully structured, and everyone who has the freedom to wander
the facility will have to be in the cafeteria at the right time to ensure they don’t miss
the most important meal of the day.
So what’s the menu like in a mental facility?
In a word, simple.
Think of your old school lunchroom or the cafeteria in an office building.
You can have something as simple as a bowl of cereal with milk, or many facilities will
offer diner-style breakfast options like pancakes or eggs.
How good the food will be varies by facility, but there will usually be daily specials - so
something to look forward to on your favorite day of the week.
But this isn’t just any cafeteria - the staff knows the patients well, and any foods
or drinks that might interact negatively with medication will be kept away from residents
who could be impacted negatively.
So some might have to go without that morning cup of coffee.
That’s not the only area where residents’ food habits may be supervised.
It’s common for residents to have one-on-one supervision after mealtimes.
This is for a number of reasons.
Some might have eating disorders that would lead them to try to purge their meal after
eating it.
Others, who are on medication, need to be supervised so they take their pills with food.
Others might be supervised to make sure they don’t pocket any supplies - like utensils
- that could be used for dangerous purposes back in the room.
There are many reasons someone could wind up in a mental health facility - and they
might warrant different levels of security.
Some check in voluntarily for treatment.
This is common when someone is struggling with an eating disorder or substance abuse
disorder - although private rehab facilities also exist and offer a more luxurious environment
to go cold-turkey.
But you’re not a reality TV star on their third rehab stint.
People who are struggling with mental illness like depression and worry that they could
be a danger to themselves or others could also turn themselves in for treatment - although
once you sign the papers to commit yourself voluntarily, you’re usually agreeing that
you put it in the doctors’ hands to determine when you’re released.
Of course, most residents are not in this facility voluntarily.
Most people who find themselves in a mental health hospital are committed involuntarily.
The most common method is when they’re placed on a psychiatric hold - which can happen surprisingly
easily.
If someone contacts the police or social services believing the person is a danger to themselves
or to others, it’s pretty common to place the person on a 48-72-hour psych hold, which
gives the doctors the chance to assess them.
If the person passes all psychological tests and convinces the doctor’s they’re not
a risk if released, this could be little more than a strange and scary few days.
But often, the doctors recommend a longer stay when real issues are raised - and this
can be trickier when someone is committed wrongly but is angry and terrified when questioned.
But some residents are there for a more serious reason.
Treatment in a mental health facility can be ordered by a court either at the conclusion
of or as an alternative to a criminal trial.
Famously, the lead of One Flew Over the Cuckoo’s Nest convinced a judge that he was too crazy
to stand trial - and got more than he bargained for.
But it’s common for a defendant who is found not competent to stand trial to be referred
to a nearby mental health facility.
And in more serious cases, defendants can be found not guilty by reason of insanity
or arrange plea deals based on mental instability - as happened to the shooter in the attempted
assassination of Ronald Reagan, and the teen culprits in the notorious Slenderman stabbing.
Both were sentenced to extended stays in high-security mental health facilities.
So the residents of a mental health facility can be a varied bunch - and you’re about
to spend some time with most of them.
As a resident, you’re likely to spend much of your time in various therapy sessions,
starting with community group.
This is where all the residents meet with the doctors and do some sharing and discussion
with each other.
You’ll be reminded of the rules of the facility, which govern what you can have in your room,
when you can use the phone or other electronics, and how to interact with fellow residents.
People air their grievances, and the staff does their best to mediate.
New residents will be encouraged to share things about themselves and set goals for
themselves.
Now, it’s time for some one-on-one time.
The doctors at the facility will usually meet with the patients independently to check on
their case, either in the patient’s room or in the doctor’s office.
This is so they can determine how the patient’s medicine regimen is interacting with their
mind.
The human mind is a tricky thing, and changes in biochemistry can have unpredictable results.
The doctors won’t hesitate to take patients off one medication, or increase the dose of
another, to alleviate symptoms and hopefully speed up recovery or at least equilibrium.
Of course, not all cases are stable.
Hope you haven’t been counting on a relaxed time.
Many patients have unpredictable disorders like schizophrenia that make them see things
that aren’t there or become convinced that they’re in danger.
It’s not uncommon to hear screams or sounds of people punching walls or trying to break
things.
While the facility tries to respect its patients’ autonomy as much as possible, they are ready
to sedate and restrain people when needed to protect both themselves and others.
But for those who are more stable, this is a time for a little relaxation on a busy day.
Residents can usually spend their free time reading or playing games in the common room.
It’s not uncommon for residents to form friendships among their fellow patients - although
there are some rules to follow, including no touching and no being alone in each other’s
rooms in most situations.
But it won’t be long before you’re reminded of why you’re here.
One of the most important parts of life in a mental hospital is process group.
This is where you meet with your social workers and tackle direct ways to handle your specific
mental health issues.
This is usually a small group where people who have similar struggles - depression, addiction,
etc - can compare notes.
The social workers lead residents through exercises to teach them coping mechanisms
to minimize the impact of negative thoughts and other challenges.
These groups can get emotional, and it’s not uncommon to see an outburst, but the social
workers know how to bring things back to the focus.
Next, it’s on to lunchtime - but nothing in this facility is irrelevant to treatment.
Lunch is usually simple foods like pizza, sandwiches, or salads.
While many patients can just eat with little supervision, any patient there with eating
disorders will be monitored far more closely.
They might even have a points system assigned, which will track their diet and may set back
their release if the doctors feel they’re not making progress.
And of course, any patient who has to take medication with lunch will be monitored.
The rest of the day isn’t any less busy than the morning.
After lunch, there might be different kinds of therapy including recreational therapy
- which can be as simple as watching a movie with a group while your behavior in a semi-normal
setting is monitored.
There might be education groups where you’re taught how to manage your condition once you’re
hopefully released in short order.
And to whet your appetite for that day, there’s an added bonus - visitation hour, where you
can see the people you love on the outside in a safe and controlled setting.
It’s not as strict as prison visiting hours, but you’ll still likely be monitored closely.
Life in a mental health hospital is usually pretty predictable and boring - but it wasn’t
always that way.
Go back a few hundred years, and mental health hospitals were a very different place.
Often called the less politically-correct “insane asylum” or “lunatic asylum”,
they were really more a place for containment of the disturbed than anything else.
Treatment was basic and often involved heavy restraints, and psychiatric medication was
only in its beginning stages.
While some early reports of asylums in places like Cairo had surprisingly modern innovations
like music therapy, institutions were a far cry from what they are today.
And the reasons people wound up in them were different as well.
With psychiatric science far from its current developed stage, it was easy to get “sent
to the nuthouse” for behaving erratically in public or other social crimes.
It was also not uncommon for family members to have their own kin committed because they
were acting in ways they determined to embarrass the family - often women who were acting too
independent, or members of the LGBT community who were stepping out of the closet.
And while treatment advanced in the 19th and twentieth century, sometimes those new advances
were equally barbaric - including electroshock therapy and even lobotomies to surgically
alter the patient’s personality to make them more compliant.
So do any of these barbaric institutions still exist?
While some treatments like electroconvulsive therapy do still exist, they are carefully
regulated in most countries and will only be undertaken as a short-term solution if
evidence shows that the patient could benefit from it and they consent.
Even with the most high-risk residents like the criminally insane, the focus will be on
managing their conditions with medication and giving them a higher degree of autonomy.
There was controversy when attempted assassin John Hinckley Jr, who had nearly killed President
Reagan, was allowed to be released from his mental hospital in 2016 to live at his mother’s
home - with strict conditions.
While many people felt an attempted assassin should remain incarcerated, he wasn’t in
prison - he was in a mental health hospital, and they felt he was no longer a threat to
himself or others.
But for you, there’s still some work to be done - starting with nighttime.
Dinner is similar to the other meals of the day, but with heartier options.
You’ll usually get a stew with meat and starch, and some vegetable sides.
Afterward, there will be some time to socialize and unwind, and then it’s time for closure
group.
This is where you’ll review the day and discuss any goals you set.
This can be stressful for some if they didn’t reach their goals, but the social workers
will be quick to redirect people to look on the positive side and look ahead to the next
day.
There’s just one more piece of business to take care of.
Before bed, everyone has to line up for their nightly medication.
While not everyone takes medication throughout the day, it’s likely that everyone will
be taking at least one thing before bed - often to help with sleep.
And speaking of sleep, it’s tightly regulated like everything else.
The facility has a strict lights-out time to ensure everyone has enough time for a full
night’s sleep - because tomorrow, the whole routine begins again.
And it’ll be just like the previous day - right?
Not exactly.
Every day has wild cards.
Routines will vary, some patients will leave, and new patients will come in.
Some days are relaxing, other days are chaotic, but a functioning mental health hospital has
one goal - to prepare its residents for the day they walk out that door, better able to
manage their condition, and be a healthy and productive member of society.
For more on life in an asylum, check out “Journalist Goes Undercover At Insane Asylum and Becomes
Prisoner”, or watch “The World’s Craziest ER Stories” for what goes on at a different
kind of hospital.