After spending a week in the Psych holding unit and now a few days in the voluntary psych unit of my hometown hospital, I will say the experience was a bit different from what I expected.
Before saying anything else I would like to say this: no doubt all the people who were there needed to be there for one reason or another, and the hospital is doing a good job (at least from my unqualified opinion) of treating patients effectively and compassionately. Many of the patients coming in have psychiatric issues despite being relatively well-off, having supportive families, and other strong protective factors. Of course many of them simultaneously have tragic and traumatic pasts which contribute to their risk, and we do what we can to set them up with the support and follow-up to help them reach their goals for their health, psychiatric goals, and lives as much as we can within the limits of our abilities (and healthcare system and personal/ professional boundaries).
Having come from my last rotation at the county hospital and is the street medicine symposium I can’t help but think about all the patients with complex medical and psychiatric needs that we aren’t seeing. Often times we aren’t seeing these patients because they don’t have the means or the capacity or the insight to come to the hospital when they are in crisis. Maybe they have been burned from the hospital for whatever reason. Maybe they have other social or financial barriers. It’s easy to have one’s perspective skewed by your immediate surrounding, and I’ve noticed that happening with myself recently. The people we are seeing, though perhaps no less in need, are often those who have means and those who have some form of existing support system (even if tenuous). They are like the WWII ships that came in with all the holes making the engineers think the places where the holes were are the places they need to fortify. And it’s easy to forget about the planes that didn’t make it back, and the damage they sustained which prevented their return.
I’m not saying it’s the responsibility of the hospital or of psychiatrist to round up and treat all the forgotten, “invisible” people suffering from psychiatric illness. I don’t know what the solution is here, I think more than anything this is a reminder to myself that medicine and healthcare, their benefits and their shortcomings aren’t confined to the walls of a hospital or clinic.