Two stories in today’s Boston Globe caught my eye. The first is a look at the reuse of old, closed public psychiatric hospitals throughout the state, mostly being turned into some type of housing. Typically developers purchase the properties (which is a lengthy, difficult process because the legislature must approve the sale of this public property), tear down most of the old buildings and structures, but keep one or two historic structures which are rehabilitated. Then new housing, typically apartments, condominiums, and/or affordable housing units, are built around the old structures. Since most of the old psychiatric hospitals were on vast scenic grounds (sometimes up to 200 acres), these are often pretty locations which bely their sometimes less-than-stellar approach to treatment of the mentally ill.
Why did these hospitals close? In the 1970s and 1980s, mental health treatment of the severely mentally ill switched from the warehousing psychiatric hospital approach — where patients often lived their entire lifetimes in the hospital — to smaller, group home settings, outpatient care, or day-treatment settings when possible (and some would argue, to homelessness for many). This is generally a good thing, as these newer approaches emphasized actually helping the people get better, learn new coping and life skills, and tried to help foster and nurture independence (rather than dependence on the state).
But psychiatric hospital still exist. Today, they are nearly all privately-run, for-profit hospitals. The average inpatient stay has gone from months, to 30 days, to its now current average of just 9 days. Some would say this is because our treatments have gotten so much better in the past decades, but some of us who are a little more cynical might point out that insurance companies don’t like to pay for any inpatient care beyond 30 days per year. So it’s in the patient’s best interest not to use them up all in one stay if there is a history of hospitalization.
So you’d think, in the intervening 30+ years of change from the 1970s and public psychiatric hospitals, we’ve learned a thing or two about people, their emotional needs, and treating them like, well, you know, human beings. You’d also think that someone who checked into a private psychiatric hospital would enjoy the benefits offered even to prisoners in our penal system. Simple things, like, fresh air.
Well, as the Globe points out in the second article, you’d be wrong. Many patients in private psychiatric hospitals are denied simple comforts such as fresh air, unless — ironically enough — they have to smoke. The people in charge claim this is for the patients’ own protection, since many are there for self-harm or suicidal behaviors or thoughts. Okay, but it would seem fairly obvious, even to me, that you could provide people with the opportunity for fresh air and watch to ensure they don’t try and kill themselves for that hour or two they are in a courtyard or such. It seems like a cop-out to say it’s for patient safety when it really boils down to not treating people with the simple respect and human decency they’d deserve.
I’d ask David Matteodo, quoted in the article, is that they way he would like to be treated if he were a patient? Is that the way he’d want to treat a loved one? Honestly, this is such a simple thing to offer, I would refuse to go to any psychiatric hospital that didn’t provide this basic human need.
10 comments
I would refuse to go to any psychiatric hospital that didn’t provide this basic human need.Unfortunately, having a choice about hospitalization destinations is not an option a lot of us have.
Outdoor time is used as a way to force patients to take medication. NO meds? NO outside time or fresh air. Even the smokers.
Last dedicated psych hospital I was in, the smokers got 5-10 minutes outside 3-4 times a day and the rest of us got nothing. Since I was on suicide watch, I got checked on every 15 minutes, 24/7, including having a flashlight shined on me at 3 a.m. just to make sure I was still breathing.
It’s safe to say I wasn’t worried about not getting fresh air. If you are in bad enough shape to be inpatient in a psych hospital, fresh air is not really near the top of the priority list.
Also, as a previous poster pointed out, insurance or the lack thereof tends to choose your destination for you.
Also,besides lack of insurance, it depends on which local hospital has a bed available at the time of assessment of where you go. There are no choices unless you have cash or lifetime cap of inpatient days not ran out to use a private hospital.
As far as suicide watch and the family member I refer to here: there is no suicide watch or threat. It is part of the levels system of earning outside time. Period. Until she is med compliant she cannot go outside. So far that is over 23 days right now w/out fresh air or sunlight.
When I was first hospitalized, I wasn’t too concerned about the lack of fresh air. But by the second time, I *was* concerned about the lack of exercise. In the second facility I was in, we actually took slowly-paced walks, but mostly we sat around. We had even less activity than we would have had at home. I could feel my body atrophying. As a first step, I’d stick treadmills and exercise bikes in every psychiatric facility. But I’m sure they won’t, because we might be able to figure out a way to hurt ourselves using them.
Hello,
I’m the founder of the “fresh air rights” movement in MA..thanks to all for your words of wisdom, and Dr. Grohol.
Fresh air is an important quality of life issue for many, but even beyond that, it’s a question of the basic dignity of human beings. Even if they’re “mentally ill”. Fresh air by itself doesn’t cure illness, but it can have a substantial impact on wellness.
It’s ironic that some of the wealthiest hospitals in the state are the ones that deny fresh air access. Mass. General Hospital made $250 million in profit last year. Beth Israel-Deaconess Medical Center made about $50 million, and had previoulsy planned to build a rooftop space, but inexplicably withdrew their plans.
Mr. Matteodo and myself obviously don’t agree on many things. I make sure to be diplomatic about it, although it’s trying. But I’ve studied the situation in MA for 3 years now, heard from hospital staff and many former patients, and the figure of two hospitals without fresh air is patently absurd. My research says at least 13 Mass. hospitals and likely more. Tales abound of people not being let outside because they don’t smoke, as one of these posts attests to. So, people are taking up smoking to get outside. Says a lot about medical ethics in the for-profit world, does it not?
I find it astonishing that having access to “the outside” (e.g., a courtyard or fresh air on an enclosed balcony) is a part of any hospital’s psychological treatment system. How is coercing people to do what is in their “best interests” going to help someone?
I can’t but help reflect on the irony of allowing smokers time outside because of their self-inflicted addiction, but non-smokers are discriminated against because they don’t engage in a life-shortening behavior.
As for choice, this shouldn’t even come up as all hospitals should give patients this simple access. As another poster noted, having access to fresh air isn’t going to be the difference between getting better or not, but it’s certainly not going to hurt.
And yes, if you’re actively suicidal, “fresh air” isn’t a high issue on your priority list — staying alive is. But I don’t see in any shape, form, or manner how the two are mutually exclusive. You should be able to get good mental health treatment and access to the outside in one place. It really shouldn’t be such a big deal, and we’re not certain why some hospitals are making it so by throwing up the red herring of “patient safety.”
Jon, thank you for your work in this area. It’s amazing to me this is even an issue of debate. Time for these psychiatric hospitals to wake up and smell the rights of patients.
lol…fresh air…when i was hospitalized in ’95 the smokers didn’t even go outside! i have asthma, but was expected to commune with the smokers in the rec room else i was considered not being social.
and safety…those ding-bats (referring to the staff not the patients) couldn’t keep track of a patients if they were sitting on their laps! one old senile man stripped naked and laid down in a fellow female patient’s bed!!!!! she had the misfortune of walking in on him! that night i demanded to be released stating i didn’t feel safe…i was 19 years old…worst experience of my life!!!!!!!!!!
hope there’ve been changes since my stay…but if not, there are bigger issues than fresh air
Since I last posted a comment here, my daughter has only been outdoors 1 time since June 16th in an inpatient psych hospital setting. The one time was an “exception” created by a staff member so I could bring her dog to visit. The “exception” was quickly changed to med compliance and gaining “a level” to see the dog again, or go outside again. Fresh air is being taken away to pressure conformity for medication compliance, and I am sure this is not the only hospital that does this. She is not a smoker so that cannot even be used as some sort of leverage for her. 1 time outdoors since June 16th.
I believe there is something wrong with the current psychiatric paradigm and care of inpatients psych wards and wonder what others think about air as a common dignity and restorative part in wellness. Lack of sunlight, no fresh air or exercise sounds like solitary confinement in prison.
That is just unbelievable! Really, if there’s anything we can do to help (e.g., write letters, phone an administrator, whatever), please let us know. I think many here would gladly help out if they knew what they could do!