The Modern Psychiatric In-Patient Technician: Skilled Worker or Guard?

One of my earliest memories as an adolescent in an in-patient unit was the tall, stocky men brazenly hanging around the treatment areas, lounge, and nurses station. These people were anomalous. They didn’t seem to have a purpose upon first glance. I couldn’t have been more wrong about that. A few days into my hospitalization a buzzer went off while I was in group. All the sudden, I was transported back to Nazi Germany. All I heard was loud shouting, and a frenzy of hand gestures: ” Go to your room!”, at which point, a buzzer went off, and the loudspeaker called a code on my unit. In my room I heard: “Just relax and this will go a lot easier…”. I heard a girl screaming louder and louder until the voice eventually subdued, submitted to the will of the modern psychiatric technician.

Some days however, there really didn’t seem to be a point for this group of staff to be present. During “Quiet Time”, these technicians would put up their hands, and re-direct us to our rooms. At other times, they watched us play outside if we were allowed out in the courtyard. These weren’t clinicians, certainly not peers, and yet, we were surrounded by them. They comprised the bulk of the unit’s staff around the hospital. Most of the time unfriendly, sometimes empathetic, but never an equal or someone to speak to when feeling the need the confide or open up to staff. While I never feared technicians, I certainly was very suspicious of them long before any paranoia was an issue for me.

There simply was something very wrong with this picture. Why was the largest pool of staff members, these technicians the least trained and the least educated out of all the staff at the hospital. Most of the technicians were out of high school or working part time without a higher degree. This wouldn’t be an issue if these workers weren’t charged with our safety and welfare on the unit. In the event of a unit emergency, and staff needed to protect a patient from another patient, it would be the technician that makes the judgement call on how to proceed with restraints.

Maybe my issue was that I was in a space where I was vulnerable and needed to be protected potentially from my peers. So, given the primary responsibility of the technician is safety, why call them technicians, and not guards. Weren’t we in need of safety and protection in the event of a psychiatric crisis? In the movie One Flew Over the Cuckoos Nest, this wasn’t the case. In the final scene of the movie, Randal McMurphy chokes nurse Ratchet after her final act of psychological terrorism on the unit and the death of a fellow patient. In this scene, before Nurse Ratchet loses consciousness, Randal is tackled by technicians or, guards.

Perhaps it is because I knew, if I was ever to lose behavioral control, I would be at this disposal and will of these poorly trained and quick tempered workers. The thought is frightening. Even more frightening are the allegations of abuse aimed at these workers in state hospitals and local psychiatric units in your local backyard. It happens. It happens all the time. So, what can be done? How are hospitals to completely re-organize not only their staffing but there emergency protocols.

Well, these measures are already being considered, thank heavens. The use of force is being recalled and re evaluated by many professionals in the field. My hope is that these revisions occur before too many more incidents and abuse cases emerge on the national headlines and spotlight. My suggestion is to get to know your technicians, be friendly, and open to their quasi treatment recommendations and soft Psychology. In some cases, they are included in treatment team meetings, so, smile, and put a happy face on even when you know their suggestions are often inaccurate and without scientific value. If you are lucky enough to get out of the hospital unscathed you did that much better than Randal.

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