IamA Mental Health Technician at one of the biggest hospitals in my state. AMA!

What's it like to treat people with severe schizophrenia?

Treating people with severe schizophrenia is really interesting and poses quite a number of challenges. Each case is actually pretty unique, even if they're the same type (i.e. paranoid). With some of these patients, they are very prone to aggression and anger, especially when their delusions/hallucinations are challenged. This can result in them lashing out at staff or even other patients on the unit. The goal here is to try and redirect and deescalate them before they lash out. For some patients, this is something we must do many times a day.

Beyond that, the treatment hinges on the psychiatrist finding the right medication(s) to treat them. It takes time, though. Psychiatric medicines, especially those for schizophrenia, need time to start making a noticeable difference. But they do work. I've seen patients come in with pretty sever schizophrenia and leave relatively normal.

Honestly, many schizophrenics can live their lives relatively normally and outside of a hospital. They just have to keep up with their medicines.

I hope that answered your question!

Aren't Schizophrenics the least likely to comply with their meds? I have heard bipolar/depression are the second least likely to comply.

Yes, statistically that's true.

What is your degree, how much do you make, and what motivated you to do this line of work?

I have a Bachelor of Science in Psychology with a Pre-Med distinction. I'm currently working towards getting into medical school where I plan to become a psychiatrist so that I can more fully treat these patients.

My base pay is $10.25/hr; however, pay varies among the techs and hospital to hospital. We are also paid differentials for working certain shifts and on weekends. The job is also fully benefited and includes paid vacation.

As to what motivated me, well, I've always loved psychology. Going to college for it only made me fall more in love with it. I decided that I wanted to pursue the practical side of it though. I also determined that not everything can be counselled through (i.e. schizophrenia). So I decided that if I want to be equipped to treat all possible disorders, I needed to become a doctor so that I would have medicine at my disposal as well. Working in this clinical setting has only strengthened my resolve to become a psychiatrist. I love my work and I want to help these people. Sadly, psychiatry is a highly underserviced field. That needs to change.

10.25

That's minimum wage here in BC.

Minimum wage for someone responsible for taking care of others well being.

Sadly, minimum wage in most of the US is only $7.25/hour. So, looking at that, I'm doing better than some. But yeah, it's not the most lucrative thing.

I am stunned that your salary is 10.25 per hour. That is less than the minimum wage in my city! Considering the work you are doing, you should be paid MUCH more.

Minimum wage in the US is only $7.25, so I'm doing better than that at least. I agree we should be paid more, but it's a job in my field doing something that I love. So there's that at least.

well now I can say that working in a Canadian grocery store earns as much as working in an American hospital

Yeah, it's a bit sad. Licensed positions (such as nurses and doctors) make a hell of a lot more though. It's the non-licensed staff that gets paid poorly.

How often do you see patients experiencing substance-induced psychosis? And do any of them ever relapse after recovery?

I see this very often. There is almost always at least one person in our units that is currently experiencing substance induced psychosis. Sometimes, there's a lot of them. It just depends.

The most common drugs that seem to induce this are alcohol and heroine detox after extensive heavy use and synthetic/fake marijuana. I have seen what synthetic marijuana does to people. It locks them into their own little world and, sometimes, they never come back. I'm not saying that to scare people, but I've seen it before. This one man was with us for almost two months and showed no change at all after using it. If you've ever thought about using that, I implore you to reconsider. It is far too dangerous and risky and I have seen to many people, many of whom are young, come in with problems because of it.

As for relapse, that depends. I've had patients come in like that and then they never come back and are doing well. Likewise, I've also had patients come back in the exact same state within a month. Chemical dependency is a major problem and recovery is an extremely difficult thing especially if you've let it get that bad. Recovery and staying clean is always possible, but it is a daily challenge and struggle.

Can you tell me more about the mental changes associated with synthetic marijuana that you have seen? I have never used it (nor wanted to). but I used to know people who used it quite frequently in high school and none of them seemed quite...normal after. very prone to aggression and lack of empathy in general.

It's really varied. A lot of people enter into a full blown psychosis where they are literally in their own reality and can't even really acknowledge that you're there. Others come in and out of the psychosis or just have hallucinations. I've also seen people who just became angry and belligerent from it. It often has a lasting effect even if they come out of the psychosis, usually in the ways you said. They seem more irritable or prone to aggression. Sometimes even less empathetic.

There is very little research done on this as it is a new phenomenon and a dangerous one. However, if you examine the ingredients in these synthetic marijuana blends, you'll find that the plants that induce this high are also toxic. In some cases, they are a direct neurotoxin. That's a problem for obvious reasons.

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I've not observed this in any patient whom I have come across. I don't mean that this means it never happens, but could you elaborate a bit more perhaps?

What is the best self treatment you recommend for someone having depression?

I have two top recommendations. One would be talk to someone you trust absolutely, like your best friend. Just talk and vent about what you're feeling and going through. Sometimes, you don't even need someone to respond too much. You just need someone to listen. Unconditional positive regard is a powerful thing sometimes. I know many of our patients with depression just never had anyone who would listen to them without judging them. It's what I do for a lot of them. We just talk and it really helps them.

My other big recommendation would be to write. You can type if you prefer. You can even destroy or delete it later. But write what you're thinking and feeling. Let it all out. It doesn't matter what it is. Just keep going until you feel like you're done. At the end, you'll feel a little emotionally exhausted probably, but better. We use writing and journaling for many of our patients, not just those who are depressed. It's a powerful tool!

One more thing. I know it can be hard because sometimes when you're depressed you just don't want to do anything, but try to stay active if you can. Go see a movie, go hang out with some friends, go workout, go for a run. Something. Something you enjoy! Self-care is important too.

I hope you find those helpful.

I was diagnosed with bipolar type 1 disorder 5 years ago, and was told not to smoke pot. I had a lot of trouble with smoking pot and the disorder, but ever since I finally quit it with marijuana and alcohol two years ago the disease has become more manageable. It's still very hard at times, but I feel stronger and more capable to handle the episodes.

I have several friends, with bipolar, who insist on smoking marijuana.

Given it's growing prominence in our culture, what are your thoughts on psychiatric disorders and marijuana? Psychiatric disorders being: Schizophrenia, Bipolar, Depression, ADHD et al.

Reading up on drugs and the research on them was actually something I enjoyed doing in college and even now to some extent. They're fascinating to be honest.

For a normal person (meaning someone who does not have a disorder), based on the research I've read, marijuana is safe for them to use and enjoy. It's still a smoked item, so there is always a risk of cancer from smoking it; however, it is less than that of smoking cigarettes.

For those with disorders, especially bipolar and schizophrenia, it is a bad idea to smoke it. It's been demonstrated to exacerbate these disorders. The same is true for depression more or less. In some cases, people drown their depression in marijuana use like they would with alcohol. At that point, it becomes a problem just as it would if you were using alcohol like that.

There is some evidence that people with certain predispositions to disorders can be triggered by the use of marijuana; however, the evidence is not fully conclusive and more research is needed.

Basically, if you have bipolar, I think it's a good idea to listen to your doctor and abstain from smoking. As you said yourself, it has helped you.

I'm glad to hear you're doing well and handling the episodes better. I know bipolar can be an exhausting disorder!

What happens when two people who claim to be Jesus meet?

Haha! This has actually never happened to on the units yet! Contrary to popular belief, most schizophrenics don't believe themselves to be Jesus; however, they are commonly hyper-religious. We did have one lady who believed that she was married to Jesus. When she appeared in court for her judicial commitment, she told the judge that she was married to Jesus and that the mental health technician who had accompanied her was Jesus' cousin.

do you think the stigma for mental health problems will ever lesson or go away? what can we do to help lesson these stigmas?

I think it will with time. It's already getting better. It's not gone by any means, but things are improving. Change is gradual and takes time.

The key, I think, to removing the stigma lies in educating people/the general public. They need to realize that a mental disorder is just like any other health problem and they shouldn't be ostracized or treated differently for it. We have to change the way people think about mental disorders. Once we do that, the stigma will fade.

You have seen many mental illnesses and gotten to know people that have them. What mental illness scares you the most?

I would say that schizophrenia and the explosive disorders (meaning they have sudden outbursts of anger) scare me the most because they are often the most unpredictable patients. They can seem perfectly calm and normal one minute and the next they can be yelling, swinging, cursing, throwing things, etc. I've had to deal with such things before and I've been trained in how to handle those situations, but they're always scary especially when you didn't see them coming.

On a personal level, Alzheimer's scares me the most. I've seen the degeneration of these patients on our geriatric units and seen the effects it has on their friends and family members. It's devastating and, to me, losing all of my memories and who am I as a person is one of the most terrrifying things in the world to me.

I've had to deal with such things before and I've been trained in how to handle those situations

Any tips on dealing with a person going through an enraged psychotic episode?

Give them their space. You don't want them to feel caged or cramped. That will only make it worse. Sometimes we don't have that luxury as they may try to attack patients, but it is best to do this.

Next, talk calmly to them. Ask them what's wrong and why they're angry. Validate their concerns and feelings. That can actually help a lot in calming them down. Talking calmly to someone in this state is more beneficial than people realize. It doesn't always work, but it does more often than not I'd say.

If this happened to you in everyday life, I would say that your top priority should always be protecting yourself (or those with you if there are others). If you think you're in immanent danger, get out of there. You don't have the tools that we have to subdue patients that are beyond verbal deescalation. Always be safe!

I hope that answered your question!

I just have to add this because I've seen a few people take this the wrong way: when you validate someone's feelings, you don't necessarily agree with what is happening.

For example, if someone is angry about the government reading their mind through their cellphone, you wouldn't say "I understand, I hate it when the government does that to me." But you might say, "yeah, I can understand why someone would be angry when other people don't respect their privacy." The first one, in part, re-enforces their crazy beliefs, the second one is more about their feelings.

This also works with less crazy relatives around the holidays. :-)

That was a very good addition. Thank you! You're right.

Thanks for answering that, I have a followup question. Have you ever been legitimately hurt by a patient at work?

The only injury I ever sustained was one time when I had to help restrain this lady. She was a severe schizophrenic actually. One of her hands came free and she scratched my left cheek. It was small and very shallow, so we cleaned it up and it healed in time. Other than that, I've actually never been hurt on the job.

That's not to say no one else has though. A friend and coworker of mine actually had to go get staples in his head after a patient unexpectedly acted out and bashed him over the head. He still works with us though. I admire his determination.

Do you ever get people who probably shouldn't be there?

Also, what would you say are the best and worst parts of your job?

Yes, people do end up here from time to time for no reason. They are swiftly discharged. We don't keep people who don't need to be here.

The best part of my job is interacting with the patients and making a positive impact on their lives

The worst part is the danger that comes with is, especially when you have to restrain a patient. It's never fun when that happens.

One of my biggest fears is being arrested or detained by the police and then being imprisoned in some asylum without trial or due process. Is this actually possible?

The police can take you to an ER if they believe you are behaving bizarrely and you may be a threat to yourself or others. Once there, you'd be evaluated by a psychiatrist. If they believe you are actually in need of being placed into care, the doctor can sign a document to keep you for 72. There's also a document that can hold you for up to 15 days, but that's signed by the coroner. This may differ from state to state. If they wanted to keep you longer, it would require a court order which requires a hell of a lot of paperwork, money, and effort to file. If they actually did this, you'd go before a judge and be able to present your case and then the judge can decide whether to grant a judicial committment or not.

To be honest, they don't do this kind of thing unless they have to. We almost never use a JC because most patients never need that long term of care. Really, there's nothing to be worried about. Also, just because those documents say 3 days or 15 days doesn't mean you will be held that long. You could be discharged the next day. The 3 and 15 are just maximums.

Is there a source or any information to get in touch with a psychiatrist or a mental health technician without going to the hospital?

I feel like I can't afford one, but I need one. My mental health is only getting worse, stuck between a rock and a hard place with no way out.

Nobody trusts me, my own parents certainly don't, they rip apart my mail in hopes of catching me on something that I did wrong. I own 2 possessions to my name, which is my car and my laptop.

Failure in college, failure in life, failure with women, failure with my future, everything is my fault that happens to my family, how the fuck do I get out of this cycle?

The only release I get is smoking ciggarettes and marijuana, and I'm getting to a point of almost 2 packs a day due to so much stress, my heart and lungs can barely keep up. I have less and less energy everyday.

My friends, are not friends, at the turn of a dime they will do everything in their power to save their own ass, and dump everything on me, it happened again. I don't know who to turn to so I can even vent without half the town knowing I did. Those that I can trust, live almost two hours away, but yet they never visit or call. It's such a financial strain on gas, tolls, and car maintenance that it feels like the only money I get to spend is pot or the car so I would have the car to work my meager 2 full time jobs.

Where the fuck do I go now?

There are definitely outpatient options and private practices that are outside of hospitals! You would just need to look in a phonebook or on google to find one in your area. Remember, patient confidentiality is a very important thing, so there's no need to worry about your name ever leaving their office.

I don't know how things are in your state, but in Louisiana, you can go to the ER for psychiatric reasons and the hospital will handle getting you into a facility. If things are getting really bad for you, this isn't a bad option to be honest. It sounds like things are really rough for you right now, so this may be an option to consider.

But, yes, there are outpatient options for you. Beyond that, I would encourage you to stop smoking so much. Cutting back will help as would cessation. Tobacco and marijuana are common self-medications, especially for people who are depressed. If you stopped, there'd be an improvement in your physical health and you'd have more money available. Both would likely help your mental health to.

All that being said, I definitely encourage you to seek help. It's out there, I promise, and there are options. I wish you the best of luck and I hope your situation gets better. Stay strong.

What is your favorite dinosaur?

Also, has there ever been a patient that made you question your own sanity?

Well that was an unexpected question, but my favorite dinosaur has always been a T-Rex. Ever since I was a little kid, that was my favorite!

As for a patient that made me question my sanity, yes. There have been. Usually they're the ones that get into this sort of infinite loop where you just talk in circles about the same thing. Eventually, you just have to disengage to break the loop.

There's also the patients who are very manipulative and/or needy. When I say needy, I don't mean they come ask for things on occasion. I mean they do not want to do anything for themselves. Often times this is a part of their disorder. The manipulative ones are the bigger problem as they like to try and divide the staff. They'll ask everyone working for something until they get the answer they want. It creates some discord among staff and undermines the consistency, which is their ultimate goal there.

Manipulative disorders can be very tricky to deal with.

Ahah what distinguishes the "regular" lazy people from people with such a disorder that makes them have no drive to start any kind of activity, like you said? And what do you do to help them try to change that?

I think jeth is on the right track. The problem is when it becomes damaging and disruptive to their daily lives. There is a difference there. The key there is to work with them to try and find a way to motivate them and to do things that make them happy. It is far easier said than done though and take time and effort on both sides.

How often do suicidal people come in to seek immediate help?

Based on how many patients we have who come in with suicide precautions or are flagged for attempted suicide, a lot. Sometimes it is against their will. In my state, Louisiana, there is something known as an Order Of Protective Custody. If someone knows that a person plans to take their life, they can file one of these with the coroner's office and the police will come to pick them up and bring them to the ER. They will then be transferred to one of our psychiatric units.

Some patients do come willingly once they realize they have these thoughts. Just because someone is plagued by these thoughts definitely doesn't mean they want to do it.

Also, a Physician's Emergency Certificate can be (read "will be") signed if a person expresses suicidal ideation. We always take such statements seriously. This legal document allows us to hold them for up to 72 hours for observation and treatment.

So, TL;DR, I'd say they come a lot of the time, but it's not always by their own choice.

I was hospitalized twice, voluntarily, due to suicidal ideation that persisted over a number of days. Just because you don't want to harm yourself, or even have a plan to harm yourself, doesn't mean that you won't get to that stage if left unchecked. I would caution anybody who knows of someone experiencing ideation, with or without a plan, to follow-up on it and try to connect that person with a proper mental health professional.

I additionally want to add that while some patients may present for inpatient hospitalization voluntarily (i.e. not committed against their will), the lack of mental health infrastructure in the outpatient environment may be a direct cause of their need for hospitalization. I know from one of my own hospitalizations a lack of access to a prescriber, coupled with having been on an ineffective medication regimen for months on end, was the reason I experienced a rebound of suicidal ideation on top of a deteriorating overall condition. Many counties who are tasked with providing mental health services for those who are not otherwise privately insured have limited resources, long wait times, and difficult requirements for admittance into outpatient programs (i.e. requirements which provide logistics problems for people who work, people who lack independent transportation, or who cannot physically be present at the limited hours/time of the day provided to access an intake specialist). In essence, if outpatient responses to mental illness were expanded the need for and frequency of inpatient hospitalization would decrease.

Definitely. Not all people who have these thoughts want to act on them! In fact, many of them are scared that they have these thoughts and rightfully seek help. You're right to advise people who know someone who has these thoughts to get them in touch with a mental health professional. They can help them!

I agree with you on the outpatient infrastructure too. Sadly, mental health is in a terrible state world wide. The infrastructure needs improvements and there needs to be more open and better access to it. The issues you mentioned are just some of the problems with it. I think that there is a powerful and growing push to change this, so hopefully in the future we will see a great improvement!

I'm sorry to hear about what happened with your lack of a prescribed combined with an ineffective regimen. I hope your situation has improved now though and that you don't have to go through that again.

Mental health is a very real and important thing and people are finally starting to accept that.

So basically, don't tell your therapist you're suicidal or you'll get locked up.

A PEC can only be signed by an MD. A therapist (presumably someone who doesn't have an MD) wouldn't be able to sign that. They might recommend going for inpatient observation though. The reason we take all suicidal ideations seriously is because what if it's not a joke? If the person goes home and kills themself, then it's on us.

I work as a psychiatric HCA (health care assistant) in the NHS in the UK, what do you mean by 'technician'?

Is that another name for my job or are you a nurse?

It's probably the same job. Technician is a common term used in most/all branches of healthcare in the US. Most often, they are non-licensed clinical staff unless they're a lab, EKG, or imaging technician (these do require a licensing program).

So you can compare, I'll give you a brief job description. My number one job is to carefully watch and observe the patients. I make sure they don't harm themselves or others and that their environment is safe. I also take their vital signs at specified intervals. I serve them food, help keep the unit clean, talk and interact with the patients constantly, and help them in anyway. I assist the doctors and nurses in anyway that I can. In the event that that a patient acts out, it is my job to intervene and try to deescalate the situation. If that fails, then it becomes my and my coworkers' job to restrain them so that they don't hurt anyone.

Does that sound similar to yours? It really might just be a terminology difference!

We have the exact same job :)

I've only been doing it half a year and have a cracked rib, a few lack eyes and a broken finger to show for it...

What kind of ward do you work on? I'm on an assessment ward so we get all sorts... Various levels of 'fun'

How long have you been doing the job? First job I've ever had that I look forward to going to!

Ah, yeah. I figured it was just a terminology difference! I've been working here for a year and a half now and I love it. It's my first job after I finished my undergraduate, so I'm really happy I got to go straight into my field.

My home unit is a general psychiatric unit, so we get a bit of everything, too! But I have worked on all the units, including the acute and chemical dependency units.

Worst injury I ever personally received was a small scratch to the face. A coworker of mind had to get staples in his head though.

Ever meet people and think "I'll be seeing them in the hospital soon..."?

Hmm. That's a good question actually. I can't say that I have though. Now that I've said that, I'm sure it's going to happen to me soon though.

Hi! Bipolar (former) patient here. I wanted to thank you for what you do. I know the job is incredibly difficult and sometimes even dangerous. The pay isn't what it should be. And mental health isn't given the attention it deserves. Regardless, thank you so much.

Do you think there are better ways to treat mental health patients than just locking them on a floor together? I've always wondered at setting up some kind of facility out in the sticks to be a place of healing & wellness, but as someone who's been inpatient & psychotic twice now, it felt more like a prison than a hospital.

The unit I work at is actually in the middle of a major city! I see what you're saying and I believe a compromise could be reached. I think we should allow the patients to go outside more often. On my unit, it only happens once or twice a day. I think if we did this more often and for longer, it would make them happier and it would allow them to get more fresh air and exercise. It's a win-win for everyone.

What are your opinions about /r/Tulpas?

I actually didn't know that was a thing until you brought it to my attention. I'm looking through it right now.

I can't claim to be an expert on tulpas, but from what I'm seeing, I wouldn't say they are a good and healthy thing. Psychology and psychiatry strives for unity of the mind, not its separation, so I feel like tulpas stand against that. I could also easily see how this could lead to other problems as a result of it. I just don't see how willfully inducing a hallucination and/or dividing up your mind/consciousness in some way would be helpful. Even going so far as to make it have its own persona.

So, basically, I'd say it's probably not a good thing.

How does a person suffering from severe depression usually behave? speak? Etc.

This is actually difficult to answer. Depression varies widely from person to person. Some people are very overt about it while others you could never tell by looking at them.

Usually the biggest sign is that they will appear more withdrawn. They might not appear sad or anything, but they'll willfully withdraw from social interaction and doing things much more often than normal. Sometimes there are other little changes that vary from person to person.

Really, identifying depression can be challenging because, scarily enough, usually those who are the most depressed show the fewest overt symptoms. My best advice is to just always be there for your friends. If you think they might be, for whatever reason, let them know you're there for them. They might not want to talk about it or be ready to, but knowing that someone is there for them means a lot and has a positive influence, trust me.

your advice in this thread is great

I'm glad you found it helpful!

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I can't recall personally interacting with a patient who was experiencing depersonalization; however, I am sure we have had some. As to how we would explain it, basically, we would try to reorient them to reality and help them to come back to themselves.

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The best advice I could give you is to search for hospitals in your area/surrounding area and see what one would best fit you. If you have a psychiatrist, psychologist, or counsellor who you see already, it might be worthwhile to ask them for help. They may be able to make calls that can help get you into these places easier than you trying to do it on your own. But if you were dissatisfied with the last hospital you were at, definitely don't go back. Not every facility is perfect for everyone. I hope you're able to find a better one and get the help you need. I know there are excellent facilities out there!

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That's really unfortunate that their program didn't hold up to expectations. You should be able to call the hospital itself and talk to them about the programs as well. Definitely ask your new psychiatrist about it. Let him know you had problems with the other hospital. It'll help him with trying to find your a good match.

I'm glad you like us. I know most of us do our best and the job can be daunting some days, but we love it.

Do you know if any of the staff has chosen to work in the field after personal experience with mental illness? If so, how does it work out?

I've been hospitalized for severe depression and suicidal ideation twice now. It was the mental health techs who were more helpful than anything else. Thank you for what you do.

I know at least one of our nurses has had experience with personal mental illness. I forget what she has not (mainly we don't openly discuss it as it is a private matter), but it made her want to work in this field and help patients. I think she has a unique understanding of what the patients are going through because she's been on the other side of it. She's a great mental health nurse.

I'm glad your techs were helpful to you. We really are the front line. We interact with the patients more than anyone, so we play a very critical role in their treatment. Even the doctors openly tell us that we are probably the most crucial part of their treatment. I love what I do and I enjoy helping others. I hope your depression never returns.

Hey, first off, thanks for what you do! I'm a mental health paraprofessional (MHPP) working in an outpatient facility. We treat the people the state hospital releases quite often. Most of the people we get are diagnosed with some type of psychosis, usually schizophrenia, schizoaffective disorder, etc., bipolar disorder, and major depressive disorder. We also see a fairly high amount of Axis II type disorders. I'm in graduate school for psychology and am pursuing a Ph D.

My question is this. How much experience do you have working with personality disorders? I find that a large portion (maybe 40%) of the clients I help treat have some type of personality disorder once they are on medication that treats their Axis I symptoms. Further, I'm also interested to know whether you refer your patients to outpatient facilities in order to receive therapy to help along side the medication, because rarely do I see people with severe mental illness manage their symptoms with medication alone.

Thanks for your time and best of luck to you and medical school!

True personality disorders (meaning meeting the DSM criteria) aren't too common; however, we just recently had a patient with histrionic personality disorder, another with borderline personality disorder, and yet another with narcissistic personality disorder. Overall, I we don't get a lot of them though. The criteria are pretty rigorous. In spite of that, I've gotten some good experience working with them. The personality disorders are definitely interesting to work with and are a learning experience, especially histrionic and borderline.

Before a patient discharges, we always make sure that they are set up with some form of outpatient care or follow-up appointment with an out patient psychiatrist/psychologist. It's required before we can discharge them and for good reason. But our inpatient program also uses different groups and therapies. We don't fully rely on medicine alone. You're definitely right. Patients usually need both medicine and therapy to be most effective and we do our best to provide that during their stay and upon discharge.

Thank you for a great response!

Personality disorders are kind of my specialty, if you can call it that at the Master's level of education, so I always enjoy hearing about them! I'd like to know what it was like working with the person diagnosed with narcissistic personality disorder if you don't mind answering another question. I've worked with several people with borderline personality disorder, one histrionic, and one antisocial. All have been very interesting and challenging to treat!

Working with narcissistic was very interesting. Somehow everything came back to them. Always. It didn't matter what it was, it always related back to them somehow.

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I'm not a huge fan of child psych in general to be honest. I don't mean that children are immune to psychological disorders and problems, but they are still developing so much that I think it's really hard to accurately diagnose them. I won't say that bipolar is overdiagnosed, but I do believe that ADD/ADHD is HIGHLY overdiagnosed to the point of being absurd and obvious. Yes, it is a legitimate disorder, but there is no way it occurs in that many people, especially in that age group.

I don't think it's particularly overdiagnosed.

I am a student and my major is social work through that I want to be a mental health counselor and work with a variety of people, my questions are What is one thing you wish you had know when you were first beginning in the field? What advice would you give to someone who is considering this as an occupation? And lastly what does this job do to make it meaningful?

I wish I'd known how certain patients can and will suddenly act out. The unexpectedly lashing out is always what catches you off guard.

If you're considering this kind of work, you need to be sure you have a thick skin and that you can also be calm and understanding under just about any situation. It's a very difficult job and these patients need a special kind of care and attention.

Seeing a patient have a breakthrough or go from being sad to suddenly have a glimmer of hope in their eyes is probably the most rewarding and meaningful part. I still remember when I was talking to this one young man, he was about my age. He'd sort of fallen into a bad crowd and he knew it. He wanted new friends and to get into a new kind of community, but he didn't know how. His particular interest was anime. Of all things, that's something I know a lot about. So I told him about the Louisiana anime community and the conventions that happen in the state. He lit up so much when I told him about that. I saw him at the convention I go to every year at the start of August. He saw me and stopped to thank me for everything. He's been doing amazing and has really turned his life around. He said he's never been happier. He came in for depression, self-harm, and attempted suicide. I'll never forget that.

No questions for you my friend just wanted to say you and I lead a very similar life. I work as a psych tech in a Virginia State mental hospital. Don't you just love our job? It's so rewarding to be able to help the people that we serve!

Yep! I really love it. I enjoy almost everything about it, especially when you have those moments where you know you just truly made a difference in a patient's life for the better. Sometimes all they need is someone to talk to them without judging them and I'm glad to be that person.

Hey there! I have a few questions and I appreciate you taking the time to do this AMA First, have you come across. Patient that the staff have not been able to identify? If so, how was it treated? Also, have you/the staff ever dealt with a somatization disorder? Or any of the somataform disorders? If so hat was their manifestation and how we're they treated?

Thanks for ever thing you do, I really admire your drive to help people in need.

Yes, there have been patients where it was difficult to give a diagnosis. When this happens, the psychiatrist takes their most prominent symptom(s) or the cluster of disorder that it appears to be and classifies it as Not Otherwise Specified. For example, Psychosis-NOS. These is often later changed as the psychiatrist has more interviews with the patient and collects information from family members, the mental health techs, the nursing staff, and the social workers.

As for somataform disorders, I know I have seen them listed as a diagnosis in a patient's chart before, but I do not recall much about dealing with them. They are fairly rare. Often I think it was a precipitated effect from another disorder. Most often, it's pain when there is no physical cause of the pain.

I was more than happy to do this AMA and I'm glad it's generating interest! I enjoy my work and a lot of people don't know much about how mental health really works, so I wanted to give them an inside look!

Not sure if you're still checking this. But you briefly mentioned people being admitted for substance related psychosis, or the like. How does that work? If say someone has taken a few too many psychedelics? Do they make it to your units? Do other drugs like Xanax actually help with that kinda 'ailment'?

I don't think I've seen a patient come in while on mushrooms, LSD, etc. though some have come in with a history of using those. Usually those who come in for that kind of psychosis are there because of extended and heavy use of heroine, opiates, or alcohol. The hallucinations and psychosis can be a symptom of their withdrawal too. The other common one of people who have used synthetic marijuana.

These patients arrive at our units after friends, family, or the police bring them to the ER. If the police observe someone behaving bizarrely, they will bring them to the ER for evaluation. It's for their own safety as well as the safety of others.

Normally we don't use xanax to treat these kinds of patients. We often begin a detox protocol for them which features a few medicines to help them through the withdrawal pains and symptoms as well as help bring them out of the psychosis if it is occurring.

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The way psychiatric and mental health facilities are portrayed in the media are often incredibly inaccurate and it really hurts the field as a whole. The most recent example I can think of was in an episode of Teen Wolf. That was an absolutely horrendous example of mental health. I love the show, but that was terrible.

The normal units have two beds and a shared bathroom. The windows have secure locks on them (NOT bars). The acute (severe) unit keeps only one patient to a room. All doors leading off the unit are magnetically locked and only open to authorized ID badges. It's a bit like a normal hospital. The paint job is a simple white with tile flooring, but color can vary across hospitals. My hospital usually uses a blue and white theme.

Each unit has a seclusion room which is a private room with a bed that is set a little bit off the main unit. It's used for a patient who needs to calm down from being angry or who just need a very quiet and low stimulus environment. There is also a restraint room. This a room with a bed that already has restraints attached to it. All we have to do is attach the restraints to the patients ankles and wrists. Yes, restraints are an actual thing; however, they are almost never used. They are only used in very extreme cases and there are special protocols for ensuring the patient's safety while they are in restraints.

Three questions, first what is your sandwich of choice? Second, how do your patients generally fight the stigma of having a mental illness, especially the people with schizophrenia? It seems like this vicious cycle where as soon as someone is tagged as "mentally ill," people cut off socially, and the isolation causes further illness, ad nauseam. Also, what do you think is a defining mental health challenge of the 21st century? Thanks fir doin this btw

My sandwich of choice is a club sandwich (ham, turkey, and roast beef) with lettuce, tomato, mayo, and honey mustard. Sometimes pickles, too.

I'm not sure how the patients deal with the stigma. We council their close friends and family, which helps the transition, but we can't do that for everyone they'll know or meet. What we need to do is change how society views mental illness. I believe that's already begun and many people are becoming more accepting of mental illness. Change takes time though.

Hmm. A defining mental health challenge. I would say that actually lies in depression and anxiety disorders. There has been a massive uptick in the incidence of these types of disorders, especially among young people. This is likely due to the stress that is placed on students in high school and college and the things associated with them. I remember the first day of my intro to psychology class in my freshmen year of college. My prof opened with, "You're at the greatest risk to develop a mental disorder during your four years of college. I've seen people in my classes withdraw from the university because they developed a disorder." It's true. But a lecture on the education system is for another topic.

With the progression of research and legalization going on of cannabis, do you think it is a medicine/drug that can help people with schizophrenia for example?

No, I don't believe so. All current research published in peer reviewed journals suggests exacerbation of schizophrenia and that its use triggers schizophrenia in predisposed individuals. I'm not against marijuana use in general honestly, but I don't believe that it would be effective as a treatment for schizophrenia.

I did psych rotations last year at my state's largest mental health facility. I definitely saw a huge pattern with head injuries, drugs (obviously)...but especially with "wet" (weed soaked in formaldehyde) and synthetics like K2 (synthetic marijuana). Have you noticed this as well?

Definitely. We just discharged a man who was there for disorders the precipitated from a traumatic brain injury. I also see lots of people on the units every day for drugs. Here the big one is heroine. I also see several people for synthetic marijuana as you said. That one is the most problematic though it is not as common because I have seen people who never come out of that psychosis. They're just fried, so to speak.

What are the negative aspects (or cons) of being admitted to a mental hospital? I know there are postitives to staying there but are the stigmas of a mental hospital's treatment still true (i.e. patients screaming all night and left unattended other than to make sure they haven't hurt themselves, sedation, difficulties in getting out once admitted, etc)?

Pretty much all of those cons you mentioned are things that are exaggerated and propagated by the media. At night, the units are quiet because everyone's asleep or trying to sleep. All patients are observed 24/7 and their needs are seen to as quickly as possible. We want them to be as happy and comfortable as possible.

Probably the biggest con is the restrictions place on patients. Such things are specific phone times, no clothing with strings, limited TV time, no cell phone, computer, or internet, etc.

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Anger can always be hard to deal with especially when it comes out of nowhere. Some things to try are to find something happy or positive to focus on. Break the focus of the anger. Another option would be to write. Vent out your feelings of anger and frustration. Write until you can't anymore. It'll release a lot of those feelings and you'll feel much better. Lastly, if you're a physical person, channel it into something positive or non-harmful. Go workout, run, or hit a punching bag. That should help.

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Actually, if you're actually not insane, you should be fine. Your intake interviews should help reveal that. The doctors don't keep people who don't need to be there. If they interview you and find that there is nothing wrong, they'll discharge you. I've seen it happen before. A patient came in one night and was gone the next afternoon after meeting with his doctor.

What are the common motivations for patients in the outside world voluntarily going off of their medication? At my job we frequently get calls from people who have completely lost it, then we learn later that they were off their meds. What would possess someone with serious mental illness to stop taking the medication that helps them live a normal life (aside from monetary issues or side effects)?

Financial reason are very common or access to it in some cases.

The other big one is that people start to feel better and they think they're fine. So they stop taking their medicine. Then the effects come back and often harder than ever. The problem with psychiatric medicine is that it needs to accumulate in the body to have a robust effect. If they stopped taking it for days or a week, even if they started taking it again, it would take days or a week to have a noticeable effect.

I've been hospitalized four times for suicidal thoughts / actions. Diagnosed with paranoid schizophrenia. I noticed you mentioned about many schizophrenics having aggression and anger... I'm neither, so I am wondering if you have many schizophrenics who do not fit that stereotype? I've met a few others on the units I've been on, and I found them to be very nice people in fact.

I'm sorry. I didn't mean to imply that all schizophrenics are angry and aggressive, although even they can be nice and pleasant. They just have a tendency to become like that. Anyway, it is just a common thing, especially in severe cases. In milder cases, schizophrenics are actually pretty close to normal.

For example, we have one lady who is a paranoid schizophrenic and it shows. She believes her family is out to get her and keep her trapped, but she is very pleasant to talk to and be around. She doesn't lash out.

Schizophrenia, like all disorders really, is unique from case to case. I'm sorry if it seemed like I implied that all schizophrenics are that way.

I hate to ask someone who is obviously very skilled and smart at his job a question they may find does not contribute to the conversation, but I wanted to hear your thoughts on ADD and ADHD. Is it something you deal with? I know a lot of people, teenagers, who claim to have or do have one or both of those mental issues. What do you think?

No, that's actually a very good question! One a lot of people don't ask actually.

ADD and ADHD are very real mental disorders and there are people who struggle with them every day.

That being said, it is also the single most overdiagnosed disorder in all of mental health. Research and analysis is showing this. The fault largely lies with schools and parents who don't want to deal with children being children and want to medicate them into obedient and quiet drones. The fault, of course, also lies with the doctors who constantly approve these diagnosis and prescriptions, but it is not entirely theirs.

Trust me, I have a friend who I've seen without he ADHD medicine. She can't focus no matter how hard she tried. Give her a small dose of adderall and she become what most of us would consider normal. She has the disorder. It does exist, but it is overdiagnosed to be sure.

I work as a MHT in a children's psych hospital. Have you worked with kids before? If so how different is working with adults?

I've only worked on our adolescent unit a couple of times, but it's very different. They have an entirely different set of rules for that unit and the kids can do things the adults can't or vice versa. You also have to be careful with them as they are often sneakier than the adults about things. Usually, it's not bad working with them though. They aren't bad kids, they just have mental disorders.

What is the strangest OCD you've come across?

Well, true OCD is surprisingly uncommon (at least on the unit itself); however, a lot of our patients have their only little rituals or things that they're a little anal about. Probably the strangest thing I've seen was this one lady who we had recently. She would change clothes every three hours on the dot and insist that her clothes were filthy. She'd go through about 5 full sets of clothes per day.

Have you ever seen some get "cured" from depression? I mean no more meds or therapy at all. I'm battling depression and I'm medicated as well as speaking to a therapist.. Hoping there will be light at the end of the tunnel.

Yes, I have. Depression isn't a death sentence or a permanent sentence. You can overcome it and go back to a normal life without meds or therapy. I've seen it happen before with patients on the unit and even for friends in my own life. It takes time and determination though. Believe in yourself and your own strength. You can make it through this. If you're determined, you can pull it off and eventually not need your medicine anymore. I wish you good luck! Stay strong.

Have you ever dealt with someone who has Bartonella rages?

I actually have not. Sorry!

I have heard it stated that every person has a mental illness regardless of whether it has been diagnosed or not. Is this true?

I wouldn't say everyone has a mental illness. For a disorder to be a disorder it has to be a strong deviation from the norm and also be a pervasive problem in the person's life, disrupting it.

The thing is, everyone gets sad or depressed from time to time. It doesn't mean they have major depressive disorder. Some people are a bit narcissistic, but it doesn't mean they have narcissistic personality disorder. People are unique and have their own little quirks and intricacies. That doesn't mean they have an illness or disorder. That's just normal variation across a population.

So, no, not everyone has a mental disorder.

Would you rather fight a horse sized duck or 100 duck sized horses?

Lol. I knew you'd do something like this. Well, I think I'd rather fight 100 duck sized horses. Ducks can be vicious creatures, dude.

How similar/different are mental asylums from mental health departments in hospitals? Like is a mental asylum for the severe cases of mental health patients?

This is just a terminology thing, but the term asylum is no longer used. Dedicated mental health facilities are no simply called Mental Health Hospitals, Behavioral Health Hospitals, or Mental and Behavioral Health Hospitals. I think that is to try and dispel some of the negative connotations surrounding mental health.

Now, to answer your question, I am not 100% certain. I have not worked in a dedicated mental health facility for severe cases. My hospital does have a unit for severe cases. We call it our acute unit. This unit has a much smaller population and each patient has their own individual room instead of having a roommate. Other than that, they aren't much different than the other units.

I doubt there are many other major differences between them, but I cannot say for certain. I'm sorry my answer probably isn't as helpful or as conclusive as you would have liked.

What percentage of patients do you believe are "faking it" or pretending to be crazier/more suicidal than they are, either for attention or a break from their issues? How can you tell who has genuine mental issues?

The amount of people who come in and are legitimately faking it is fairly low I think. We have had people come in and it became very obvious very quickly that they were only here to avoid pending legal issues.

Sometimes patients don't think they're ready to be discharged or are afraid of leaving the unit, so they suddenly start acting worse than before. It does happen.

That being said, we do have some frequent visitors who are very much attention seeking. For example, one patient we have has been there at least 10 times in the year and a half that I've worked there. He almost always comes in because he cut himself. These cuts are always very superficial (literally just deep enough to draw a little blood) and not indicative of suicidal intent. When he's on the unit, he tries to get everything he can exactly when he wants it and always tries to bring attention to himself.

The best way to get a feel for if someone has a genuine mental health issue is to talk to them often and to read their assessment and progress notes by the doctors and nurses. You can get a good feel for them just by talking to them honestly.

Basically, yes, some people come in here faking it for various reasons, but I think it is a very low percentage.

What has your experience with BPD been? Have you ever seen anyone successfully return to a productive lifestyle? Maintain healthy relationships (significant other/family/friends)?

Yes, it is possible. The key lies in proper therapy and the right medication combination. I have seen borderline patients return to their normal lives and never come back to the unit. It's definitely possible! It takes a little work from everyone though.

Why is it that mental health facilities tend to treat their patients as if they're children, even if it's very clear that the patient is competent, functioning, and in reality, may not have any real issues?

Could you be a bit more specific? If you're referring to things like the restrictions placed on patients (i.e. no strings, phone times only at specific times, etc.), then the answer is that we have to apply those rules to everyone. If we gave certain patients special treatment/exemptions to the rules, other patients would complain and possibly even act out, creating a bigger problem. If that's not what you're referring to, please be a little more specific and I'll try my best to answer!

The social treatment. I understand there is a need for professionalism, but in my (several) short experiences with such hospitals, I realized that staff often socially treat the patients as if they are children. "Do you want to watch cartoons?" to older, non-senile patients (ageism, I'd call it) for example.

OH, I see what you mean. That's something that shouldn't happen and in my experience usually doesn't happen on our units (excluding the adolescent unit where they are, in fact, children). We allow the patients to choose the TV channel they want to watch. In general, I don't think we try to treat them like children. When they ask us why rules are a certain way, I always try to explain the actual logic and reason behind it rather than just "well those are the rules".

On my home unit, we especially expect the patients to act like adults, so we treat them as such. By and large, they usually respond well to that. If you treat them like adults, then they won't act out or get as frustrated.

I am sorry to hear that your experience was like that though. I hope that if you ever have to go back in the future, your experience will be better. I promise not all of mental health treats its patients like they're children!

What would be the best way to get a family member who is terrified of treatment to actually get the help they need. Said family member is 75 years old with a history of depression and is bipolar. She went off a couple of months ago and is currently experience mood wings, crying jags, sleeplessness and whole host of behaviors that are really disheartening for those of us who care and can see she is suffering needlessly. We know she needs to go to a psychiatrist and get new meds. She refuses to go. What can we do?

If she is honestly as bad as that and she refuses to go, there is always the option of an order of protective custody. I believe all states have this option in some way. With Louisiana, you sign this at the coroner's office and the police will bring her in for evaluation and placement at the hospital. From there, the psychiatrists can evaluate and treat her. I know such an option may be hard, but if things are that bad, it may be for the best. I hope that helps!

Thanks for taking the time to answer my questions. My family is slowly coming to agreement that we need to step in. It will be hard at first but it's for the best. Thanks again.

It might be hard, but it's for her best interests. Committing a family member is never easy.