Burnout (working in a psychiatric hospital experiences)

Burnout – (burn • out) – noun

1. a phrase used to describe a state of emotional and physical exhaustion caused by excessive and prolonged stress;

2. a term mental health workers use to describe when they no longer give a shit about bag searches, safety checks, or any other pain in the ass detail of their job

Alongside the paranoid patients fighting their thoughts of “Damn it, something is out to get me” us psychiatric hospital workers are fighting our thoughts of "Damn it, maybe I should have majored in business." Many things can cause burn out. For me it was the lack of sleep, my frustration with the mess that is the mental health system (fuck you managed care), and the responsibility of being authority over people in crisis. I hate authority. I have always hated authority and now I am authority. I enjoyed hating and defying authority figures when I was growing up and now in some sick twist of fate the tables are turned. Karma, looks like you win. If some of my former authority figures witnessed this they would probably laugh their ass off and say something spiteful. My sixth grade conflict resolution teacher would probably say, “Ha! That’s what Chris gets. So what if I put on way too much cheap makeup and my complexion coupled with my obesity made me resemble a human orange? I had to go to therapy over that comment asshole.” I wasn’t that bad though. Most of my other teachers would probably just say, “Chris V? Who the heck is that….. Oh yea, that quiet dude that sat in the back all year and never took anything seriously. Whatever happened to him?” That brings me to my next point. I have always been a quiet and shy person. This is unfortunate, because my job has required me to say things like:

“We cannot let you back into your room until you take your urine test.”

“You aren’t allowed to masturbate in the observation hall. We have people sleeping around here. Under no circumstances. I don’t care if you got away with it on night shift.”

“Please don’t do that (masturbate) in the quiet room, or any room for that matter. We have people walking by here.”

“Please don’t touch me or physically touch staff again without asking. That’s absolutely inappropriate and makes me feel very uncomfortable.”

Fortunately, over time and repetition certain phrases have become like scripts. Scripts that I have learned to say respectfully and in a non-demeaning way. It’s all about body language and being polite but firm when you need to be. That’s easier said than done though. It can be pretty hard to be polite and say: “It’s our policy to safety search all new patients that come to the unit. Please take off all your clothes except your underwear.” I guess I have gotten used to it. But still, sometimes after I say that I feel like the host of “To Catch a Predator” is about to pop out of a door and say “Hi Chris, why don’t you take a seat?”

Although my shyness and “type B not caring about enforcing rules” personality don’t exactly mesh with being an authority figure in a very structured environment with people that are sometimes very difficult, I can manage. The working conditions and the mental health system are what really burn me. It's a very frustrating thing when you are underpaid, overworked, and exposed to a variety of horrors like thrown urine, smeared shit, spilt blood and the occasional HIV positive aggressive patient. Lots of risks are taken in our field, even more demands are put on us and we don’t get a lot in return.

Working at any hospital, psychiatric or not, bleeds into your home life because worst case scenarios happen, and the nurse managers always see you as a phone call away, especially when you are PRN like me. They don't care about your plans later that evening, or the fact that you have been working the past seven days and need some sleep. I’ll give you an example: One time a young female patient attacked a female staff member and hurt her pretty badly. A male staff intervened and got hit a couple of times in the face before more staff got there and restrained her. Both staff members had to go to the hospital. Now the hospital is two staff short and has a very violent and very naked patient banging on a locked seclusion room door. As a result of this situation, I received a frantic phone call around 10am on a Saturday, "WE NEED YOU HERE URGENTLY! THE PATIENTS ARE ALL BATSHIT CRAZY AND WE ARE WAY SHORTHANDED!! THE SKY IS FALLING!! AHHHHHHHHHH!!!!" Ok, Ok... My manager didn't actually say the last couple of sentences but believe me they were implied. The point is I am sitting at the computer in my boxers with my balls hanging out and all I feel like doing is eating a burrito. The last thing I feel like is going to work, especially when I know I am going to be walking into a war zone. Now I have to scramble to come up with some half-ass excuse to cover up my real reason for not wanting to work: "It's my day off and I don’t feel like it. I want to watch cartoons.” I try to respond to people, but with school obligations and my failing attempts to maintain a social life that doesn't qualify me as a hermit, this can be a challenge.

My email box is also loaded with a bunch of emails to the tune of: "WE NEED MALE STAFF FOR THE NIGHT SHIFT FEBRUARY 10th! WE ARE WAY SHORT AND WE NEED HELP FROM YOU! THAT MEANS YOU!" I can’t even escape from you guys on the internet. How the hell did they get my home email again? Oh yea, I put it on my employment application. Crap. Now I am going to feel slightly guilty for completely ignoring them.

Did I mention the environment? Many days when I walked into the adult unit I got short of breath and felt tightness in my chest. The air on the crowded adult unit is thick. The thick air mixes with the fear of the unknown and creates discomfort. You never really knew what you might walk into, or what could happen. Not to mention that it is sometimes very difficult watching people lose their battle with mental illness. If they were winning they wouldn’t be at our hospital. I remember doing bag searches and seeing the letters and pictures that some patient’s children sent them. I remember a drawing of “we love mom” written in poor crayon handwriting with a stick figure family portrait next to it. All the stick figures had smiles on their faces. I hope that child never knows how different her depressed mother was from that bright, smiling stick figure rendition that day. I could tell that patients were loved by the way their mothers over-packed for them, sending them way too many snacks and clothes, with their favorite shirts folded just how they like. It reminded me of my mother and how important I was to her. She would always over pack for me when I was a kid. I can only imagine how devastated she would be if I was locked in a psychiatric hospital. Thoughts like these can make your job a lot harder.

So why do I keep doing this when I could be making a lot more money with a lot less stress somewhere else? Well, I could give you the same lame ass answers that I give everyone else: "I care a lot for the patients; I like working with people; I want to make people's lives better; and I believe that this is an important job." These are definitely true. It is very satisfying to be in a field that is directly benefiting individuals that are hurting. It provides me with an invaluable sense of purpose and self-worth. That’s definitely part of it, but not all. I could have chosen to become a lot of other things that could provide me with that though. So what is it that draws people into this field? Kindness? Fascination? Stupidity? All of the above? An employee at a psychiatric hospital in Boston had this to say:
"I mean, what possesses an otherwise rational and intelligent individual to dedicate their livelihood to working with people who are mentally ill? Obviously a big soft heart which automatically aches at the sight of the doomed attempting to make their way in the world with a brain ravaged by major mental illness. The other quality is that taste for the edge. Come on, people. Ninety percent of the population goes through their day with no awareness that there are four hundred people out in our psychiatric wards who experienced some of their feelings as audible voices driving them to do things like attempt to slice their dick off with a kitchen knife. And YOU deal with them each and every day. So any claim you have to being a totally normal and well balanced person is right out the window. In fact, you are probably a very special person who has some sense that there are things more important than what kind of clothes you wear, what kind of car you drive or whether you have your own parking place. But there is also this very wide subversive streak in you which prefers the edge to any sort of safe middle-class life. Fuck beaver cleaver and the horse he rode in on. Give me real life. Give me someone who needs a self-inflicted cigarette burn to feel alive, and let me talk them out of it.The edge. Only those that know it can really talk about it."

Hmmm, that sounds about right. I was there for dozens of restraints, patient on patient assaults, patient on staff assaults, suicide and escape attempts. I’ve grown accustomed to the reassuring “click” that a syringe makes after it has emptied anti-psychotics into a patient’s butt muscle while hospital workers are holding down their limbs. I saw numerous patients strip off their clothes and run around the unit naked. I had my ass grabbed more times than I would like to admit (by females and males). I have seen a grown man threaten to kill himself because he couldn’t find the top to his hairspray (worst case of obsessive compulsive disorder I have ever seen). I even saw a 60 year old dementia patient tackle a staff member half his age like a linebacker on steroids (yes, it was freaking hilarious. If I had a camera that day we could have made youtube.com history.) Experiences like those are why I loved my job. They made me scared and stressed but part of me likes that. Fuck normalcy and routine, I want unpredictable. During the easy days when the patients were mostly compliant and sane, part of me felt unsatisfied. Part of me thought, “What a boring ass group of patients. I thought that this is a psychiatric hospital. You guys are way too chilled out. Where are the severely mentally ill? Let’s bring in the psychotic guys I see on the streets on the way to class. I bet they know how to make things uncomfortable. I want to see some random and senseless aggression. Let’s shake things up.”

I have always been fascinated with the severely mental ill. When I was six years old, I used to ride the train to go to Georgia Tech football and basketball games with my father. It was there that I saw mental illness for the first time in the faces of homeless men and women. They were unlike anything I had ever seen. They looked wild and unpredictable. I remember being absolutely terrified of them. While everyone else purposefully looked away, I couldn’t stop watching. I was captivated by them. I don’t really know why. I can still remember a couple of them. My mother said I always had an unhealthy fascination with things that scare me. I guess fear and interest have always gone hand in hand for me and this field delivers both. The patients are an endless source of intrigue, amusement and fascination. What an amazing field to be in.

 

Very well written. How did you get into this field? This is something I have wanted to do for a long time.

 

hey. so i just read this and i thought it was so amazing. this was so inspiring to me. i am only 17 but i know i want do to something like this. my parents thought i was insane when i told them this, and i never knew how to explain why i was interested in this. now i absolutely know why i want to do this. thank you so much for posting this, its so awesome!!:2thumbsup:

 

Like as is said-"it's a dirty job,but someone's got to do it'". Takes a caring human to tend to those with serious "bad brain wiring'. You definately qualify.
Two friends that worked a mental warehouse in Hawaii told me they dreaded the full moon.
I too ,have always been fascinated by the human condition and probably should have done what you are doing. So it goes. Hang in.

 

Ive kinda wanted to do this kinda work. Thank you for sharing
Its interesting

 

Great write!

 

For two years I was head of security at a psychiatric hospital and I’ve experienced everything you’ve described and more. I must have personally attended to 600 code oranges which meant someone was going in restraints.
We had one female patient who was diagnosed with hypersexuality disorder (or Nymphomania) and I didn’t even trust her around my own security officers charged to make sure she stayed in her room; for fear her voluptuous 17 year old body would entice them into doing something that would get them fired and bring a lawsuit against the hospital.

Hotwater

 

Great write. I have always wanted to work in one as well. I am thinking of getting a grad degree in psychology and becoming a counselor or group therapist.

I spent enough time in them to be able to identify with them. What really put this in my head was a group therapist in one I was in who was also in one and went through bad depression, drug use, etc. People really lit up to him more than the other therapists.

@Hotwater - Code Orange is it? I have been a code orange. They were screaming "he's a kicker!". If there's a next time I'll yell CODE ORANGE! lol

 

I've never got it from the other side's perspective. I've always been the patient.