Return to my Psych/Addiction Roots - “Inpatient”

A couple of weeks ago I filled-in for the head of social work in the locked psych/addiction unit across the hall from the partial hospitalization day program that I usually work in.
After starting my career working for three years in a public detox where I was always fascinated by the patients that never slept, those that seemed to never get out of bed, and those that would be carrying on conversations with, well, people that were not there, I found myself spending the next fourteen years working the locked units.

My compassion and empathy are on ‘over-drive’ when I work on these units. I more often than not find myself drawn to the people with Bipolar Disorder that are either in a manic, depressed, or in a mixed state of mind.
Being a person with Bipolar Disorder (Type II) I can understand probably better than most of the staff what they are going through.
This is not to say that I believe “only” people with Bipolar Disorder can work with those that have Bipolar Disorder. Quite contrary, I feel the need to be careful so as not to disclose or share my personal experience in order to maintain a therapeutic relationship as a professional, rather than a ‘mutual’ one.

You have to love my brethren though. Talking to a patient that was in the tail-end of a manic episode, everything he was talking about made perfect logical sense. That is until his concluding remark to me. ‘Willy, do you think they will release me Friday? I have to be at the Boston Commons by 4pm on Saturday to catch the flight back to Jupiter!’
‘Hmm, maybe we should play that by ear regarding Friday, o.k? o.k.’ There is something about the camaradiere that staff share on an inpatient unit that you will not find in any other area of the Psych World. Due to the possible volatility of the patients at a moments notice, staff watches each others backs constantly. Sort of a professional hyper-vigilance. At every facility I have worked over the years all the staff was on a first name basis (yes, even the doc's). A nice human to human touch
So here I am wrapping up a weeks work inpatient with an hour and a half to go and it happens. A new admission decides that he does not want to be on a 'locked' unit and he literally, 'loses it.' Next thing I see in the hallway are two mental health workers on either side of the patient holding him as he is trying to break free from them and crash the locked-door. I'm thinking, 'wonderful,' as I race down the hallway to help them contain the patient. Most of my assistance is holding him from behind so he can't twist to the sides to get away. After what feels like an hour (real time probably 5-10 minutes) the patient calms down to the point where one of the mental health workers can get him to talk rationally.

I felt relieved that he did not have to go into restraints and was willing to take medication to further calm down. Nothing 'sucks' more on an inpatient unit then to have to do a four-point restraint. When I first began in the field if the patient was in an open area on the unit acting out staff would be assembled for what was termed in those days a 'show of force.' Really? A show of force? Now there is language just destined to escalate a situation, right? It's us, against them. That is why in the early nineties I changed it where I worked at the time to a 'Show of Support.' You know, human to human (and yes, I am taking credit for that phrase). I did enjoy getting back to my roots again though. I like to joke that I know I am doing a great job inpatient when it takes the patients a couple of hours to realize that I am a staff member due to my wild sense of humor. 'Hey, where did you get the staff name tag from? What? Your a staff member? You can't be, you are as crazy as we are!'

No, I am a human being just like you are...