I know what it is like to lose control. It’s the worst feeling in the world. In my two decades of living with a chronic mental health disorder, I’m no stranger to feeling like I’ve lost some self-control. Most of my life and recovery has been about self-management. Learning how to regain a sense of self-mastery and control over my thinking and behavior. The truth is, during the tenure of my illness, I have been so emotionally labile, and psychotic impulses sublime into uncontrollable behaviors. Losing control is one of the most complex parts of living with a mental health disorder. When patients lose behavioral control in an ER setting or CPAP, they can count on admission to the hospital. Staffed with plenty of folks to assist if a person loses behavioral control, ERs and CPAPS have many technicians to ‘help.’
Charged with the safety and supervision of patients, technicians in hospitals, ERs, and CPAPS assist with nutrition, vital signs, and hygiene and help patients with ADLs. The most significant responsibility of technicians is maintaining a safe and supportive environment in inpatient settings. In this sense, technicians won’t hesitate to restrain and subdue you if you step over that line and evidence loss of behavioral control. Losing control in an ER or CPAP may result in the administration of psychotropic medication to reduce further risk of self or harm to others. Losing control has awful, sometimes long-term, permanent implications: loss of friends, inpatient hospitalizations, self-harm, reckless behavior, etc. Losing control is much more extreme than letting ‘letting off some steam,’ and it is more volatile and destructive. Manners, politeness, and etiquette take a back seat when someone loses “behavioral control.”
I’ve seen very low-key and relaxed people undergo what seemed like a complete personality transformation as a clinician and peer. It was as if every hinge connecting the person to the world broke, unhinged them from any responsibilities to themself and the world. I think of the loss of behavioral control as a very frightening feeling.
Hospital patients with extreme affective dysregulation sometimes benefit from clinical intervention and support. Usually, this feeling is quite scary and otherworldly. All sense of safety seems to vanish in seconds. Psychiatrists and clinicians in psychiatric hospitals concern themselves with the term’ behavioral control’ to evaluate a patient’s mental status. When a person’s mental status is in free fall, so is the threat to their safety. Losing behavioral control means a person is likely less safe when left to their own devices and more at risk of harm. Technicians are often left to make the judgment call to intervene or not. Whether a person is more a risk without intervention than with really shouldn’t be left to technicians, but this is what happens on the unit.
Only a few days into my first hospitalization, the thin veneer of calmness on the unit seemed to vanish. That was when a loud buzzer went off. I was in a group where other patients were working with a therapist. Suddenly, I heard a lot of movement. Doors opened to the unit, and technicians from the other teams flooded the hallways with a frenzy of hand gestures:
“Go to your room!” the technicians advised us without anyone’s consent. I remember hearing a patient and technician in the adjacent room: “Just relax, and this will go a lot easier…”. I listened to a girl screaming louder and louder. Eventually, the loudness faded and sounded subdued as the patient submitted to the psychiatric technician restraining the patient to a crash cart.
I recommend that all people under a technician’s supervision be respectful. These poorly trained staff members often misunderstand and misrepresent the behavior of patients on the unit. Technicians comprise the largest pool of staff members in psychiatric hospitals. They are the first people to greet you when admitted to the hospital and the first point of contact on the unit. Technicians are also the least trained in mental health, psychology, and crisis intervention out of all the different mental health professionals in the hospital. Not an issue if technicians weren’t in charge of the immediate safety of patients on the unit.
Senior technicians in clinical rounds with patients and their treatment teams must be trained clinically. Going around the room during rounds one morning, I listened to technicians recommend what sounded like Pseudo-Psychology when it was their turn to offer their thoughts and treatment recommendations. I’ve had to smile and say, “thank you, I’ll try that,” when I knew the technician’s suggestions were without merit and scientific value. And still, some technicians are respected above their station and training. If you are shocked, think about your workplace and professional environment. Haven’t you seen people with fewer credentials and experience sometimes make decisions above their pay grade? The same happens in mental health and inside the unit in clinical settings.
In the event of a unit emergency when staff needs to protect a patient from another patient, the technicians often, depending on the threat and risk of immediate harm, make judgment calls to proceed and restrain patients before psychiatric or social workers can intervene. Shouldn’t clinicians have the first and last words when restraining patients? The sad truth is when a patient loses behavioral control, they are at the disposal of technicians. Hospitals need to re-organize not only their staffing but also their emergency protocols completely. Until the use of force by mental health professionals gets reformed, institutional abuse cases will continue to emerge in the national headlines.
Author Info:
Max E. Guttman
Max E. Guttman is the owner of Mindful Living LCSW, PLLC, a private mental health practice in Yonkers, New York.
