Hospital psychiatric wards now feel like prisons, some say

New safety standards aimed at limiting suicide risks have led to overhauls inside hospitals around the country, with psychiatric facilities and wards removing bathroom doors, stripping artwork from walls and requiring patients to wear paper gowns instead of their own clothes.

The changes have forced costly renovations and caused a backlash, with some critics contending they’ve made hospital rooms feel more like jail cells.

Regulators say the new guidelines leave room to protect patient dignity and privacy, but many hospital officials tasked with updating facilities and their procedures say they’ve gone too far.

In this Oct. 10, 2019, photo, Patricia Rehmer, left, Hartford HealthCare Behavioral Health Network president, talks with state Rep. Mike Demicco, D-Farmington, at the Legislative Office Building in Hartford, Conn. Rehmer said new rules related to patient suicide are restricting patient dignity and freedom. (AP PhotoChris Ehrmann)

“I think we are moving toward a very prison-like system,” said Patricia Rehmer, president of the Behavioral Health Network for Hartford HealthCare, which operates Hartford Hospital. “We try and make it comfortable, we try and have as many things available as we can, but it’s not easy.”

New suicide prevention requirements took effect on July 1 on orders of The Joint Commission, an agency that works with the Centers for Medicaid and Medicare Services and accredits the vast majority of the country’s psychiatric hospitals.

A 2018 report by The Joint Commission Journal on Quality and Patient Safety found an estimated 49 to 65 hospital suicides happen annually. The report was described as the first data-driven estimate of inpatient suicides per year in hospitals.

In this Oct. 1, 2019, photo, Michaela Fissel, executive director of Advocacy Unlimited, sits at her desk in her office in New Britain, Conn. Fissel thinks changes to safety standards at hospital psychiatric units are making the environment harsher for the patients. (AP PhotoChris Ehrmann)

In general, now pictures cannot be hung on walls, doors on bathrooms are either removed or replaced with polystyrene foam doors, and remotes are removed for televisions that are now secured behind plastic glass. Ceiling tiles and door handles must be replaced with risk-resistant ones along with special types of beds and sheets.

“We’re buying the same furniture and plumbing fixtures as prisons and jails,” said Dr. Bruce Schwartz, president of the American Psychiatric Association, adding that the requirements are creating harsher environments in psychiatric facilities.

Several organizations with the Michigan Health and Hospital Association have struggled to comply with the new requirements in the timeframe expected by The Joint Commission, said Laura Appel, the association’s senior vice president and chief innovation officer. She said empty rooms may be safer but they’re also significantly less comfortable.

In this Oct. 1, 2019, photo, a painting sits above a couch at the office of the nonprofit Advocacy Unlimited in New Britain, Conn. The nonprofit organization works with people dealing with mental health issues, addiction and homelessness, among other traumas. (AP PhotoChris Ehrmann)

“The lack of doors means an insult to patient privacy,” she said.

Mental health advocates have raised concerns that less comfortable environments for patients could be less healthy.

Michaela Fissel, executive director of Advocacy Unlimited, said hospitals could make the settings more homelike and comfortable by adding yoga or music and letting patients wear their own clothes instead of a paper garment.

In this Oct. 10, 2019, photo, the Connecticut Behavioral Health Partnership Oversight Council meets at the Legislative Office Building in Hartford, Conn. The group includes legislators, behavioral health advocates and consumers, state agencies, and medical and mental health practitioners. (AP PhotoChris Ehrmann)

One patient, Cheyenne Wilson, said she felt as though she were in solitary confinement when she was admitted to Hartford Hospital’s psychiatric unit for half a day when she was experiencing suicidal ideation. She said she had her belongings taken and searched and was told to get dressed in a paper garment.

“They took my clothes away and made me get dressed behind a curtain, not even in another room,” she said.

Her father, Beresford Wilson, co-chairs the Connecticut Behavioral Health Partnership Oversight Council. He raised his daughter’s experience at a September meeting and said it had too much of a punitive feeling.

This Oct. 1, 2019, photo, shows the building of Advocacy Unlimited in New Britain, Conn. The nonprofit organization works with people dealing with mental health issues, addiction and homelessness, among other traumas. (AP PhotoChris Ehrmann)

“I think to make the experience as normal as possible when the person is under that distress, what they are looking for is normalcy as much as possible, not restriction or confinement,” he said.

After her experience in the emergency unit, he said his daughter was given a therapy referral and has been taking classes to become a certified nurse assistant.

Dr. Charles Herrick, chair of psychiatry for the Western Connecticut Health Network, said the changes can make patients feel more depressed and can demoralize them.

“If you perceive the environment as a prison — and prisons are a place of punishment — then you can’t help but think you are being punished, whether consciously or unconsciously,” he said.

In response to criticism of the new guidelines, Joint Commission officials say they believe hospitals should be able to protect patient dignity and privacy while meeting safety standards.

“Balancing privacy and safety is always an important factor when caring for patients at-risk,” the agency said in a prepared statement. “It is vital for organizations to develop procedures to ensure that individuals are regularly reassessed so the level of security/monitoring implemented is appropriate for the assessed level of risk.”

The cost of renovating spaces and buying new equipment is another reason some hospitals have objected to the new requirements.

Partly citing such costs, two hospitals in Ohio and Wyoming closed their psychiatric units within the past couple of years. Officials from both hospitals declined to comment.

Certa also said the hospital also had to purchase safety sensors for about 48 doors, costing $785,600 in total.

On average, the length of stay for psychiatric patients at a psychiatric facility is seven to 10 days, according to the American Psychiatric Association.

A movement away from institutionalization over the last half century has led to community-based mental health services replacing long stays in psychiatric hospitals. That same trend has also coincided with larger numbers of mentally ill people becoming homeless or incarcerated, where they receive little treatment — or none at all.

Chris Ehrmann is a corps member for Report for America, a nonprofit organization that supports local news coverage, in a partnership with The Associated Press for Connecticut. The AP is solely responsible for all content.