While psychiatric-ward stays have saved many lives (including mine), overall, they aren’t always the best way to deal with a depressive. Since psychiatry has become crisis-oriented, however, they’re a necessary evil. They will continue to be, until psychiatry becomes less crisis-oriented.

One of the main problems with putting depressed patients into psychiatric wards, is that they’re often thrown in with a hodgepodge of other patients, who have other sorts of mental illnesses. Now, I don’t mean to put those other patients down, but people with mood disorders are quite different from people with, say, psychotic disorders. The comparison is not always a favorable one, and the message conveyed to a patient who already feels rather poorly about themselves, is that this is “their place.”

Most psych wards are restrictive, in that one cannot just walk around the hospital grounds. Again, this is for safety reasons, however, a patient can feel as if he or she is in jail — which again isn’t conducive to improving his or her state of mind.

As I said, the real problem is a crisis-orientation. Patients are allowed to get worse and worse, but remain on their own, and when they get bad enough — that is, when they’re suicidal — we stuff them into a “mental illness warehouse” to keep them safe. Then, for too many, cycle resumes all over again.

Again, I have to say that I am not impugning the caring or dedication of the people who work in psychiatric wards. I’m simply suggesting that psych-ward visits be eliminated in the first place, by not allowing depression patients to degrade to the point where they need to be “locked up” for their own safety.

In simpler terms, we need more intermediate treatment options than are usually available. We also need inpatient facilities which are devoted specifically to those with mood disorders, in which the environment isn’t so restrictive and, well, depressing.

A very good intermediate treatment option which currently exists, is known variously as “partial hospitalization” or “day treatment.” My best hospitalization experiences have been in such venues, and I cannot recommend them highly enough. Unfortunately, they are usually used (as in my case) as follow-up after an inpatient hospitalization, and not proactively to prevent an inpatient stay.

The reasons for this are varied, but they come down mainly to two: Staffing, and insurance. A hospital’s priorities are naturally going to be in its inpatient units, where “the worst of the worst” are. Outpatient treatment is secondary, and often suffers from budget cuts or consolidations. Insurance companies are generally unwilling to pay for outpatient programs unless they’re convinced it’s necessary in order to keep a patient out of an inpatient unit — but by the time that point has been reached, an inpatient stay is sometimes already required!

In any event, very few inpatient facilities cater specifically to mood-disorder patients, even though they comprise the majority of the mentally ill. This makes no sense, but it remains a fact. A facility for those with mood disorders could be constructed so as to offer some freedom of movement for patients, but with little compromise on their safety.

Most inpatient wards have a schedule of activities for each day; they don’t want patients sitting in bed feeling sorry for themselves. Obviously, keeping them active is a good idea, but unfortunately, more and more inpatient units are not maintaining sufficient staff to run all of these activities. Hence, while “on the books” they can claim to keep people busy, in practice, they don’t.

Most units offer one or more sessions of group psychotherapy a day. While these are probably useful to people who’ve been “through the system” and know what to expect, for most patients, who are in rough shape (otherwise, they wouldn’t be there!) and new to such environments, it’s utterly useless and sometimes frightening. Something much better would be a simple check-in followed by exercises or some other form of activity.

Another problem that many inpatient wards have, is that attending psychiatrists are usually treating several people at a time. Even the best of them can get mixed up, or drained, or inattentive to those who don’t make their presence felt. Unfortunately, most people suffering a severe depressive episode, are (by definition) unable to make their presence felt and demand the psychiatrist’s time. Hence, they get only minimal, assembly-line treatment.

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