3 MIN READ | Mental Health

Maxwell Guttman, LCSW

Psychiatric Hospitals Need to Re-Organise Not Only Their Staffing But Also Their Emergency Protocols

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Maxwell Guttman, LCSW, (2021, July 14). Psychiatric Hospitals Need to Re-Organise Not Only Their Staffing But Also Their Emergency Protocols. Psychreg on Mental Health. https://www.psychreg.org/staffing-emergency-protocols/
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I was an adolescent in an in-patient unit, but who were the tall, stocky men brazenly hanging around the treatment areas, lounge, and nurse’s station? These people were anomalous. They didn’t seem to have a purpose at first glance.

I couldn’t have been more wrong about that! A few days into my hospitalisation, a buzzer went off while I was in a group. All of a sudden, it felt as if I was transported back to Nazi Germany. All I heard was loud shouting and a frenzy of hand gestures: ‘Go to your room!’ at which point, a buzzer went off, and the loudspeaker called a code on my unit.

I heard a patient and staff member in the adjacent room: ‘Just relax, and this will go a lot easier.’ I listened to a girl screaming louder and louder until the voice eventually subdued, submitted to the modern psychiatric technician’s will.

Some days, however, there really didn’t seem to be a point for this group of staff to be present. During ‘quiet time,’ these technicians would put up their hands and redirect us to our rooms. At other times, they watched us play outside if we were allowed out in the courtyard. These weren’t clinicians, indeed not peers, and yet we were surrounded by them. They comprised the bulk of the unit’s staff around the hospital.

Most of the time, they were unfriendly, sometimes empathetic, but never an equal or someone to speak to when feeling the need for confiding or opening up to staff. While I never feared technicians, I certainly was very suspicious of them long before any paranoia was an issue.

There was something very wrong with this picture. Why was the largest pool of staff members, these technicians, the least trained and the least educated out of all the hospital staff? Most of the technicians were out of high school or working part-time without a higher degree. This wouldn’t be an issue if these workers weren’t charged with our safety and welfare. In the event of a unit emergency and staff needed to protect a patient from another patient, the technician makes the judgement call to proceed with restraints.

Maybe my issue was that I was in a space where I was vulnerable and needed to be protected potentially from my peers. So, given the technician’s primary responsibility is safety, why call them technicians and not guards? Weren’t we in need of security and protection in the event of a psychiatric crisis?

In the movie One Flew Over the Cuckoos Nest, this wasn’t the case. In the movie’s final scene, Randal McMurphy chokes evil nurse Ratchet after her last act of psychological terrorism on the unit and a fellow patient’s death. In this scene, before Nurse Ratchet loses consciousness, Randal is tackled by technicians or guards.

Perhaps it is because I knew that if I were ever to lose behavioural control, I would be at the disposal and will of these poorly trained and quick-tempered workers. The thought is frightening. Even more alarming are the allegations of abuse aimed at these workers in state hospitals and local psychiatric units in your local backyard. It happens. It happens all the time. So, what can be done? How can hospitals completely re-organise not only their staffing but their emergency protocols?

Well, these measures are already being considered, thank heavens. The use of force is being recalled and re-evaluated by many professionals in the field. I hope that these revisions occur before too many more incidents and abuse cases emerge in the national headlines and spotlight. My suggestion is to get to know your technicians, be friendly, and open to their quasi treatment recommendations and soft psychology.

In some cases, they are included in treatment team meetings, so smile and put on a happy face, even when you know their suggestions are often inaccurate and without scientific value. If you are lucky enough to get out of the hospital unscathed, you did that much better than Randal.


Maxwell Guttman, LCSW teaches social work at Fordham University. He is also a mental health correspondent for Psychreg.

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