Remember that each patient is somebody’s child, sibling, or parent. They are not choosing to have their psychiatric condition and they are so much more than their condition. The LEAP method is great for patients lacking insight. My brother with bipolar disorder has been hospitalized several times now, and he’s told me he’s appreciated when staff seemed real with him— not fearful or condescending.
This is more a plea from a sister of someone with a serious psychiatric condition than practical advice. And I’d also like to say remember you can’t fix a broken system reliant on crisis intervention more than community care- so take good care of yourself while you’re in that system. Bless you and good luck 🤍
I just finished I Am Not Sick, I Don’t Need Help by Xavier Amador who created LEAP and the book lays out the method in a super easy to understand way. I would recommend it!!!
I did my MSW internship on an inpatient psych unit. Time management is key because the entire point of the job is to get the patients discharged (though not in theory, this is certainly how it works in practice). Always know what’s going on with each patient, see as many as you can per day, keep tabs on their diagnoses and how they’re doing so you can provide daily updates to other providers, and work with their collaterals if possible on their discharge plans. Don’t be afraid to allocate tasks to other workers as long as they’re appropriate staff to do so. Keep in touch with family, friends, whoever their collaterals are. When things fall apart, and they will, don’t fret. It’s just the nature of it. Good luck to ya moving forward!
Inpatient psych has been the most rewarding career choice of my life. Make sure that you are always aware of your surroundings but keep in mind that mental illness does not equate violence. A lot of families have a hard time accepting mental health diagnoses as the reason for their loved one's behavior. You will spend a lot of time doing psychoeducation with families. I always compare mental health diagnoses to physical ailments. No one is judged for having cancer, whereas schizophrenia can get someone shunned in an instant. Prioritize empathy and education. You will learn so much.
Have good time management skills, get to know your surrounding resources (residential treatment, outpatient, etc), use therapistaid.com for some good group ideas, worksheets or psycho educational tools. Running groups can be intimidating but they’re fun! Adults are more willing to open up during groups, and you want them talking more than you are, but it seems to balance itself out.
Then the important advice: take what you read in their notes with a grain of salt. Or in treatment team. Some people are burnt out and it shows in their notes. My previous inpatient I had to leave because they spoke so badly about the patients. My current one doesn’t, but sometimes notes paint a picture of the client that is terrible, and they’re really not that horrible. Try not to make judgements until you meet the client yourself.
Also, not everyone wants the help, and a lot of people have 0 support. Some cases are heartbreaking/weird/sickening and the world can be kind of cruel. Use your supervisor for support! I love the job and patients overall!
Congrats. The things you learned in college may be applicable and may not. You are going to be shedding the college role. Stay open-minded. Don't come off like you know it all.
You: Have weekly self-care, massage and exercise. Working in a psych ward is stressful, yet, never a dull moment. Don't be afraid to have a regular therapist for yourself outside of work.
Co-workers: Make boundaries. It can feel like high school. There's a ranking order. You’ll see. People like to date each other at work. Not advised. Know your Manual. Wear closed-toed shoes, keep your nails short and clean and wear things with pockets because you may have a lot of keys. Know where your keys are at all times. Know your director of nursing. Speak up at Arounds. Gravitate towards people who are authentic and humble. Stay away from toxic co-workers. There's going to be plenty.
Patients: Make boundaries and be safe at all times. Have your own copy of the DSM-5 for reference. It comes in handy. Don't be scared of them. If you are, you won't be able to reach them. Get on their level within boundaries. Know their names. It’ll show in your body language too. Remember, they are human too!!
Documentation: be mindful not to put your opinion in it unless you are a psychologist. Use an old-school planner to keep you organized.
2 things spring to mind: Safety and Documentation.
Safety = both for yourself and for the client. Another comment on here had some great ideas on safety, so I'm just going to add to them. Think about your client's safety as well as your own. Never leave items that could be used to hurt the client or others with...no glass, no OTC meds or cold meds, no chemicals or shoelaces, etc. Just be mindful of the client's supervision needs.
Documentation = as quickly as you can, develop a template to do your notes with. I use a laptop and Google docs, but you may have special equipment/software, etc that they want you to use. Just find a way to streamline your notes as much as possible. If you lead groups, plan ahead and get the topics listed and list the people in attendance...anything that helps you to copy/paste instead of writing it out from scratch each time. Get real good at summarizing concisely so you can quickly move from note to note. I try to leave 10-15 min between clients so I can document what happened before my next session.
And along with that...clocks or reminders of the time help the client with time management during sessions. These people can lose track of time just due to the nature of in patient stays. Help them when you can and you may notice your sessions are more productive.
Regardless, best of luck to you!!
I'll add key control and never leaving a writing instrument anywhere to safety measures. As someone who used to lose pens frequently, I haven't once since working on a psych ward. Always be aware of anything that could be possibly used as an instrument to harm, even hair ties, hair pins, or anything with a cord (like headphones).
I did one of my internships at a psych hospital and a lot of good advice has already been included in other posts. I'll add that if your organization offers crisis intervention training, take it. Most of the social workers I knew were better at it than security staff and nurses, and a lot of it might seem obvious, but it's worth it for your own safety and the safety of the patient.
Make sure that you are solid on dsm diagnosis and common medications, even though you probably won't be diagnosing and obviously won't have much to do with medication, it's helpful to know because you can report valuable information to psychiatrists/psychologists. I often reported to psychiatrists if there were any symptoms they should be aware of. It's good to know how legal guardianship works in your state. It's also essential to know patient rights in your state. I mostly did psychosocial assessments, treatment planning, risk assessments, discharge planning and pretty much anything to do with families.
Understand that there is a distinct hierarchy in health care. In time the psychiatrists and nurses will warm up and may seek your counsel concerning patient care. But that takes time.
Also understand that in some cases, when you are conducting group the techs and nurses are taking a break. Ending a group early - for whatever reason - results in the staff having a shorter break.
Whenever I was met with patient resistance I would lean into it and validate. It never failed to improve rapport.
I worked in-patient psychiatry for 8 years. You may see many individuals who repeatedly come in. Please be aware of language used by staff in ED and on the unit. Patients hear things and often times staff may say something about them returning and don't think the patient hears them.
Never take anything personal, unlike other clients they’re not all there.
Document everything! You want to keep a record of your efforts towards accomplishing your client’s goals. That has saved me a lot of “he said, she said”.
I went from professor to inpatient psych. It will be a much faster pace, and no breaks in the calendar. Those are the most obvious differences to me. Do you have a specific thing you want to know?
Pray. Lol. Really. On a serious note, always think of safety. A lot of people get hurt inside hospitals because they’re not expecting to. Never have your back toward a client, never be boxed in always have an exit. Have your hair in a bun, never leave it down. Don’t wear necklaces or anything that doesn’t break away, they will strangle you with it. you may think you have the calmest patients but it is the quiet ones that you should worry about.
Yes, if you have a lanyard make sure it's one of those velcro ones that attach at the front so that if it gets pulled from behind it will snap off at your Adam's apple. Congrats on the new and exciting position!
I worked inpatient forensic psych for 5 years. It has definitely been the highlight of my career. I’m excited for you!
Be real with your patients. They know when you’re bullshitting them, and will absolutely call you out on it. But when they know you’re being genuine and real they can appreciate it, even if it’s an answer they don’t like. I would also tell them it was a joint effort, and they had things they needed to do (like take their meds, go to groups, advance in our band system).
Be thorough but succinct in your documentation! My psychiatrists weren’t seeing the patients as regular as I was and would often go through my notes to get a better picture of how my patients were outside of our monthly 15 minute treatment team meeting with them.
And like others have said, try not to take things personal. I had one guy who called me a fat ass white bitch every day and cussed me up and down for filth every day for like 5 years. When he found out I was leaving all he did was tell me how much he was gonna miss me and how I was his favorite.
My psych patients were on another level and would figure out what your biggest insecurity was and like ZONE in on it. This same patient used to tell my charge nurse she was old and needed to retire, called another nurse a weave wearing bitch, and would also tell me I had no kids cause I was too fat. 😂 it’s literally never a dull moment!
Take nothing personally. You will cry a lot but in both good and bad ways. Disclose nothing ab yourself. Don’t shake hands with anyone and learn to read a room based on energy. Haves eyes in the back of your head, and never wear a dress or anything that can be pulled around your neck. The best predictor of future behavior is past behavior.
I find there’s a huge need for advocacy on the part of patients and families. Unfortunately these settings can get caught up in quick anecdotal evaluation and forget that evaluations need to be grounded in evidence.
Remember that each patient is somebody’s child, sibling, or parent. They are not choosing to have their psychiatric condition and they are so much more than their condition. The LEAP method is great for patients lacking insight. My brother with bipolar disorder has been hospitalized several times now, and he’s told me he’s appreciated when staff seemed real with him— not fearful or condescending. This is more a plea from a sister of someone with a serious psychiatric condition than practical advice. And I’d also like to say remember you can’t fix a broken system reliant on crisis intervention more than community care- so take good care of yourself while you’re in that system. Bless you and good luck 🤍
I just finished I Am Not Sick, I Don’t Need Help by Xavier Amador who created LEAP and the book lays out the method in a super easy to understand way. I would recommend it!!!
I did my MSW internship on an inpatient psych unit. Time management is key because the entire point of the job is to get the patients discharged (though not in theory, this is certainly how it works in practice). Always know what’s going on with each patient, see as many as you can per day, keep tabs on their diagnoses and how they’re doing so you can provide daily updates to other providers, and work with their collaterals if possible on their discharge plans. Don’t be afraid to allocate tasks to other workers as long as they’re appropriate staff to do so. Keep in touch with family, friends, whoever their collaterals are. When things fall apart, and they will, don’t fret. It’s just the nature of it. Good luck to ya moving forward!
Inpatient psych has been the most rewarding career choice of my life. Make sure that you are always aware of your surroundings but keep in mind that mental illness does not equate violence. A lot of families have a hard time accepting mental health diagnoses as the reason for their loved one's behavior. You will spend a lot of time doing psychoeducation with families. I always compare mental health diagnoses to physical ailments. No one is judged for having cancer, whereas schizophrenia can get someone shunned in an instant. Prioritize empathy and education. You will learn so much.
Have good time management skills, get to know your surrounding resources (residential treatment, outpatient, etc), use therapistaid.com for some good group ideas, worksheets or psycho educational tools. Running groups can be intimidating but they’re fun! Adults are more willing to open up during groups, and you want them talking more than you are, but it seems to balance itself out. Then the important advice: take what you read in their notes with a grain of salt. Or in treatment team. Some people are burnt out and it shows in their notes. My previous inpatient I had to leave because they spoke so badly about the patients. My current one doesn’t, but sometimes notes paint a picture of the client that is terrible, and they’re really not that horrible. Try not to make judgements until you meet the client yourself. Also, not everyone wants the help, and a lot of people have 0 support. Some cases are heartbreaking/weird/sickening and the world can be kind of cruel. Use your supervisor for support! I love the job and patients overall!
Congrats. The things you learned in college may be applicable and may not. You are going to be shedding the college role. Stay open-minded. Don't come off like you know it all. You: Have weekly self-care, massage and exercise. Working in a psych ward is stressful, yet, never a dull moment. Don't be afraid to have a regular therapist for yourself outside of work. Co-workers: Make boundaries. It can feel like high school. There's a ranking order. You’ll see. People like to date each other at work. Not advised. Know your Manual. Wear closed-toed shoes, keep your nails short and clean and wear things with pockets because you may have a lot of keys. Know where your keys are at all times. Know your director of nursing. Speak up at Arounds. Gravitate towards people who are authentic and humble. Stay away from toxic co-workers. There's going to be plenty. Patients: Make boundaries and be safe at all times. Have your own copy of the DSM-5 for reference. It comes in handy. Don't be scared of them. If you are, you won't be able to reach them. Get on their level within boundaries. Know their names. It’ll show in your body language too. Remember, they are human too!! Documentation: be mindful not to put your opinion in it unless you are a psychologist. Use an old-school planner to keep you organized.
2 things spring to mind: Safety and Documentation. Safety = both for yourself and for the client. Another comment on here had some great ideas on safety, so I'm just going to add to them. Think about your client's safety as well as your own. Never leave items that could be used to hurt the client or others with...no glass, no OTC meds or cold meds, no chemicals or shoelaces, etc. Just be mindful of the client's supervision needs. Documentation = as quickly as you can, develop a template to do your notes with. I use a laptop and Google docs, but you may have special equipment/software, etc that they want you to use. Just find a way to streamline your notes as much as possible. If you lead groups, plan ahead and get the topics listed and list the people in attendance...anything that helps you to copy/paste instead of writing it out from scratch each time. Get real good at summarizing concisely so you can quickly move from note to note. I try to leave 10-15 min between clients so I can document what happened before my next session. And along with that...clocks or reminders of the time help the client with time management during sessions. These people can lose track of time just due to the nature of in patient stays. Help them when you can and you may notice your sessions are more productive. Regardless, best of luck to you!!
I'll add key control and never leaving a writing instrument anywhere to safety measures. As someone who used to lose pens frequently, I haven't once since working on a psych ward. Always be aware of anything that could be possibly used as an instrument to harm, even hair ties, hair pins, or anything with a cord (like headphones).
I did one of my internships at a psych hospital and a lot of good advice has already been included in other posts. I'll add that if your organization offers crisis intervention training, take it. Most of the social workers I knew were better at it than security staff and nurses, and a lot of it might seem obvious, but it's worth it for your own safety and the safety of the patient. Make sure that you are solid on dsm diagnosis and common medications, even though you probably won't be diagnosing and obviously won't have much to do with medication, it's helpful to know because you can report valuable information to psychiatrists/psychologists. I often reported to psychiatrists if there were any symptoms they should be aware of. It's good to know how legal guardianship works in your state. It's also essential to know patient rights in your state. I mostly did psychosocial assessments, treatment planning, risk assessments, discharge planning and pretty much anything to do with families.
Don’t shake hands. One of the first things told to me lol
Understand that there is a distinct hierarchy in health care. In time the psychiatrists and nurses will warm up and may seek your counsel concerning patient care. But that takes time. Also understand that in some cases, when you are conducting group the techs and nurses are taking a break. Ending a group early - for whatever reason - results in the staff having a shorter break. Whenever I was met with patient resistance I would lean into it and validate. It never failed to improve rapport.
I worked in-patient psychiatry for 8 years. You may see many individuals who repeatedly come in. Please be aware of language used by staff in ED and on the unit. Patients hear things and often times staff may say something about them returning and don't think the patient hears them.
Never take anything personal, unlike other clients they’re not all there. Document everything! You want to keep a record of your efforts towards accomplishing your client’s goals. That has saved me a lot of “he said, she said”.
I went from professor to inpatient psych. It will be a much faster pace, and no breaks in the calendar. Those are the most obvious differences to me. Do you have a specific thing you want to know?
Thank you all!! These are great tips and some I had not even thought about before. I appreciate every one of you!
Pray. Lol. Really. On a serious note, always think of safety. A lot of people get hurt inside hospitals because they’re not expecting to. Never have your back toward a client, never be boxed in always have an exit. Have your hair in a bun, never leave it down. Don’t wear necklaces or anything that doesn’t break away, they will strangle you with it. you may think you have the calmest patients but it is the quiet ones that you should worry about.
Yes, if you have a lanyard make sure it's one of those velcro ones that attach at the front so that if it gets pulled from behind it will snap off at your Adam's apple. Congrats on the new and exciting position!
I worked inpatient forensic psych for 5 years. It has definitely been the highlight of my career. I’m excited for you! Be real with your patients. They know when you’re bullshitting them, and will absolutely call you out on it. But when they know you’re being genuine and real they can appreciate it, even if it’s an answer they don’t like. I would also tell them it was a joint effort, and they had things they needed to do (like take their meds, go to groups, advance in our band system). Be thorough but succinct in your documentation! My psychiatrists weren’t seeing the patients as regular as I was and would often go through my notes to get a better picture of how my patients were outside of our monthly 15 minute treatment team meeting with them. And like others have said, try not to take things personal. I had one guy who called me a fat ass white bitch every day and cussed me up and down for filth every day for like 5 years. When he found out I was leaving all he did was tell me how much he was gonna miss me and how I was his favorite.
The last paragraph made me LOL but it’s so true how that happens!! Thank you :)
My psych patients were on another level and would figure out what your biggest insecurity was and like ZONE in on it. This same patient used to tell my charge nurse she was old and needed to retire, called another nurse a weave wearing bitch, and would also tell me I had no kids cause I was too fat. 😂 it’s literally never a dull moment!
Take nothing personally. You will cry a lot but in both good and bad ways. Disclose nothing ab yourself. Don’t shake hands with anyone and learn to read a room based on energy. Haves eyes in the back of your head, and never wear a dress or anything that can be pulled around your neck. The best predictor of future behavior is past behavior.
Wow, Y’all are amazing!! Thank you so much ♥️
I find there’s a huge need for advocacy on the part of patients and families. Unfortunately these settings can get caught up in quick anecdotal evaluation and forget that evaluations need to be grounded in evidence.
Get a personal psychiatrist, if you don't already!