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Working in a Psychiatric Hospital: The Good, The Bad, and the Ugly

I have been a mental health professional for over 20 years. I provide case management services for people with developmental disabilities.


It took me a year to find a job after graduating from college so I jumped at the opportunity to work at a local psychiatric hospital. The pay wasn’t great but I saw it as an opportunity to actually gain some experience in my field of study.

Basic Duties

My official title was a mental health worker. This position is sometimes referred to as a mental health technician. This is an entry level position but carries tremendous responsibilities and potential liability.

1. Assisting with Admissions- Part of my job was to assist with patients with the admissions process. This included checking baggage as well as the person for any dangerous objects that can be used for harming themselves or others.

2. Checking Vital Signs- I checked blood pressure and temperature of the patients. This is usually done at admission and in the mornings. Patients on the substance use recovery unit are monitored every two hours.

3. Monitoring- Mental health technicians monitor patients for safety. Rounds are usually conducted every 15 minutes. Patients on suicide watch or close watch are often require a separate form of documentation to verify that they were monitored for safety. It is extremely important to monitor at night. Sometimes you have to change your pattern in some cases. Patients that are extremely suicidal will try to time your bed check and then harm themselves between rounds.

4. Crisis Intervention- Everyone admitted into the psychiatric hospital is in some form of crisis or mental distress. Some may be in a mild state of depression, some may be self admitted the substance abuse treatment unit, while others are admitted because they are a danger to themselves or others.

Typical time out room in a psychiatric hospital.

Typical time out room in a psychiatric hospital.

Crisis intervention includes using verbal techniques to prevent a situation from getting worse. Sometimes verbal intervention is unsuccessful and physical intervention is needed. Mental health workers and nurses are trained in using physical techniques to safely prevent someone from harming themselves or others. Two of the most utilized programs that I know of are Therapeutic Options and MANDT.

Therapeutic Unit

Most of the patients in this unit admit themselves to the hospital due to depression. These patients are usually not psychotic and do not present a significant danger to others. They still need to be monitored for safety. This usually consists of 30 minutes checks during the day and 15 minute checks at night. There are usually support groups facilitated by licensed clinicians during the day.

Substance Use Recovery Unit

Patients on the substance use recovery unit are also primarily self admitted or with the assistance of family. It’s important to maintain a close eye on the patients due to the physical withdrawal symptoms. Vital signs were taken every two hours during the day. If their blood pressure readings are too high or too low, they are transported (by ambulance) to the nearest hospital. Hospitals also need to be careful because some patients on this unit are HIV positive due to drug use. Hospitals usually have an internal code or sign they use to indicate the status of the patient. This is for employee safety and this indicator is never exposed to the public. Working on the recovery unit was a good experience but it was also a difficult watching people go through withdrawal. The worst withdrawal I have ever witnessed was a young man who was going through detox from cocaine, heroin, and alcohol. People shake, moan in pain and sometimes lose control of their bodily functions. It was defiantly an eye opening experience.

Locked Unit

This unit is primarily for involuntary admission to the hospital. These patients are often experiencing psychotic symptoms due to not taking their medications. They have also presented suicidal or homicidal behaviors. They have been screened by a trained clinician and determined to be a danger to themselves and/or others. This is referred to as a temporary detention order or TDO. TDO patients are required to remain in the hospital for 72 hours before they go before a judge. The judge will then determine if the patient is stabilized or will need an extended time for more treatment.

I spent most of my time on this unit. The primary reason was because I’m a male. Just about every shift there was someone who needed to be restrained and they preferred to have more males on that unit. The physical restraining of people and seeing them in four point restraints on a daily basis took a toll on me. It was physically and emotionally draining. I realized that it needed to be done for safety but seeing people strapped down on a bed never sat well with me.

Typical leg/arm restraint used in psychiatric hospitals

Typical leg/arm restraint used in psychiatric hospitals

Night Shift

I started working night shift and it proved to be yet another challenge. It was more of a physical adjustment for me than anything else. My primary concern with night shift is the limited staff. Many psychiatric hospitals staff their facilities based on census. This means that the amount of staff is based on how many patients or on the unit. In my situation, it was usually just me and a nurse on staff with a unit of 12 patients. Do you see how this could be a problem? If there was an emergency, we could call for help from another floor. Of course, this takes away from their staffing and creates a domino effect. A third night staff person was usually added when the census is around 18. Nighttime is often the time when many people go into crisis. I remember one night we had six admissions in one shift and that wore me out. These admissions can be violent and sometimes the police are needed to help make the situation safe.

The Good

This was my first job out of college and it gave me an opportunity to gain valuable experience in the field of psychology. I was exposed to several treatment units and was able to learn crisis intervention skills. I was able to get a better understanding of clinical depression by working with patients directly and learning from more seasoned employees.

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The Bad

One of bad aspects of the job was the low pay. It is an entry level position but the pay is not enough considering the level of physical risk involved. Low pay leads to high turnover. Of course turnover is another major problem with these types of jobs. Many feel the risk is not worth it and they move on to higher paying jobs.

The Ugly

The job of a mental health worker can take a major physical and emotional toll. While working at the hospital, I was bitten on the arm and had my glasses ripped off my face. I was also threatened countless times. I was never really in fear of any of the patients but as a human you just get tired of dealing with the verbal abuse on a daily basis.

In general, I feel that my experience working at the psychiatric hospital was beneficial. It taught me how to handle crisis situations in a professional manner. I developed a thick skin for the threats, insults, and abusive behaviors. I realized that it was the illness, not the person that was actually lashing out at me. I learned not to take it personally. This is difficult because we are all human and it can be difficult to ignore. This is especially difficult for a young person experiencing this for the first time. Experience is really the only way you can improve in this area because at the end of the day, you are the professional and you have exhibit self-control.

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2014 Martin D Gardner


drdspervez from Pakistan on March 10, 2018:

Nice article,you are right that after completing your studies you need to get a job if it is not up to your wishes then also to remain in profession you have to select a job & with passage of time you start loving your work place and the people around you.

Larry Rankin from Oklahoma on July 28, 2015:

It is essential we have people willing to work with the mentally ill.

Very informative.

jtrader on October 18, 2014:

Certainly we all can learn a lot from your experience. Developing a thick skin is essential in life. Sometimes we all encounter people who act in unacceptable ways because of factors that have nothing to do with us.

Martin D Gardner (author) from Virginia Beach on September 10, 2014:

Epbooks, It definitely takes a special person to do that on a long term basis. I realized quickly that this would be a short term experience for me.

Elizabeth Parker from Las Vegas, NV on September 10, 2014:

I can only imagine how difficult it must be to work at this type of hospital. I don't think that I could do it!

Martin D Gardner (author) from Virginia Beach on September 09, 2014:

Thanks! And thanks for sharing your experience Denise.

Denise W Anderson from Bismarck, North Dakota on September 09, 2014:

Having been a patient at a psychiatric unit, and having had family members as patients, I take my hat off to those who are able to work in these types of environments. It is not an easy place to be, either for the patient or the worker. Thanks for sharing your perspective with us!

Martin D Gardner (author) from Virginia Beach on September 08, 2014:

Thanks. The hospital I worked at was very professional. I’m sure some of the large institutions have issues with abuse. The job is definitely not for everybody. I can honestly say that people were treated with dignity and respect in this particular hospital.

Mel Carriere from Snowbound and down in Northern Colorado on September 08, 2014:

Sounds like a grueling job. I have heard horror stories from the patient perspective, and I am happy you have not reinforced them. You sound like you did your job humanely and conscientiously. Great hub.

Martin D Gardner (author) from Virginia Beach on September 08, 2014:

Thanks for stopping by Sangre and Ms. Dora. Yes my skin is as tough as leather now lol. It really takes a lot to bother me.

Dora Weithers from The Caribbean on September 08, 2014:

Now I would work in a psych hospital; I may not have said yes in my younger years. It takes a lot of compassion and understanding to do this kind of work for little pay. Very smart of you to expose yourself to this experience and thanks for sharing.

Sp Greaney from Ireland on September 08, 2014:

It sounds like a tough job to do. I think having a tough skin like you mention is not something we all can achieve.

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