What could make a hospital admission more healing and less exhausting? Drawing on personal experiences, the writer shares what life is like behind the doors of a locked ward and offers a number of concrete suggestions for improvement.
It’s about light, calm, and spaciousness – but also about communication, integration, or simply getting a proper meal. Small changes can make a big difference when you’re struggling to find your footing during a difficult time.
Written by Pedro Monzó
Improving psychiatric hospitals is not an easy task. Many patients with different diagnoses must live together for some time. Each one has its quirks and fears. Each diagnosis has its challenges and peculiarities. Likewise, the physical and emotional impact on each patient is different. Some patients have just entered the hospital, and others will soon leave. There is not a one-size-fits-all approach to finding the perfect hospital.
However, some things are changing for the better.
A new national psychiatry plan was approved in 2022. The 10-year plan focuses, among others, on increasing capacity, improving treatment quality, and reducing patient readmissions. The changes aim to create calming, therapeutic environments rather than restrictive ones, reducing traumatic experiences.
The plan also mentions, among other measures, better coordination between hospitals and municipalities or issues related to prevention and early intervention.
That said, small changes can make a big difference. Creating warmer environments, introducing more variety of activities, or improving communication with both the patients and the staff are just a few examples.
This article describes some suggestions for improvement based on my experience as a patient in a Danish psychiatric hospital during the spring and summer of 2021.
The patient’s room & the lighting
Some studies claim that suicide rates in bipolar are higher during the spring. On the one hand, sunlight affects melatonin and serotonin levels, which regulate mood. These hormonal changes can destabilize people with bipolar disorder. On the other hand, changes in sleep patterns due to longer days (especially in Nordic countries) can trigger episodes of mania or hypomania – which usually are followed by depressive periods.
Sleeping is crucial, especially during a crisis. Once I become unstable, my sleep cycle is the first thing to be impacted. When I entered the hospital, the sun rose at 5 p.m. and set at 11 a.m. The curtains in my room were almost non-existent, and the sunlight poured in, waking me up—if I was lucky enough to be asleep. Coupled with feelings of depression, waking up at 5 a.m. was not an option for me. It would be helpful to equip bedrooms with curtains that allow more light options.
The patient’s room is often where patients spend more time. Hence, a light that provides quietness, a warm environment, and the ability to adapt to different situations is recommended.
Out of my room, sometimes I had the feeling of dimming the light. I am quite sensitive to sunlight when I’m struggling. It’s similar to someone who has a migraine and wants to hide in a dark room. The windows in the hospital were mostly like those in my room, it was also difficult to isolate oneself from the sun. Those days were much longer; like living three days in one. When you are feeling down, you need to call it a day early enough, and I felt trapped for too many hours.
I know the importance of circadian cycles and natural light systems that help us sleep. In the same way, especially when we are depressed, we must go out for walks and sunbathing. Nevertheless, patients should be able to use the facilities for their light exposure benefit.
On the other hand, different rules apply during the winter. As there is less natural light, it is inevitable to use artificial light, but in some cases, it is too bright, cool and harsh. This type of light may be suitable in areas where the staff work. However, in spaces such as corridors, where patients can spend a lot of time, this light can be bothersome.
Each space covers different needs and purposes. The lighting must be aligned with the main objective, the well-being of the patients and the staff.
Out of my room
When you are dealing with anxiety, it’s hard to find your place. Anyhow, the environment can help calm you down or increase your restlessness.
The main common area on my floor was a fairly small lounge consisting of three sofas, a TV and some space for drawing or doing a puzzle. During the day, television usually broadcasted news or programs, sometimes with somewhat catastrophic or violent content. I spent some time there, but it wasn’t such a cozy place.
There was another small room with a board tennis table and a treadmill that I used when I started to feel better. There was a nice terrace that also was a smoking area. Some other rooms were similar to meeting office rooms which, for example, we sometimes used at night to play cards. There was also an outdoor green space where art workshops were held.
My floor had a bit of an institutional look. It also resembled an office. It had the somewhat cold appearance that hospitals usually have. One can expect a minimalistic and clean look in the hospitals, but also a warmer one. F.ex a Nordic decoration with more comfortable furniture, warmer light, calming colour schemes, nice plants or pleasant paintings. A decoration to create an atmosphere in favour of the well-being and quietness of both the patients and the staff.
I would also have liked that the common spaces were better tailored to their usage and purpose.
Routines & Activities
I would have liked a daily calendar with more activities. Having more choices could give perspective and a purpose for the day, even and especially when you are struggling. It saves time overthinking.
We had an art workshop. There was a room for yoga and stretching. There were also talk sessions between the patients but I couldn’t participate. It did not look enough.
A few examples of these activities and rooms could be:
1/ Yoga, mindfulness, meditation, sensorial activities.
2/ Games ( board games, digital games, collaborative games )
3/ Soft Fitness
4/ Cultural ( music, cinema sessions, reading corner )
5) Body expression ( dance, theatre)
6) Gardening
7) Training on mental health issues
8) Rooms to foster the interaction among patients
A monitor could guide some activities; it would not be necessary in others. Some activities could be done individually, and others could be done in a group – group activities foster interaction and build support networks among patients. The spaces used for the different activities would have usage rules, schedules, and some organisations to prevent excessive or inappropriate use.
Integration
One of the main challenges was the language. Unfortunately, I couldn’t speak or understand Danish. During the first few weeks, it was especially hard. People surrounded me and at the same time, I felt a little lonely. I felt the need to share my emotions and problems. I missed a bit of empathy from the staff and better communication. I didn’t have many opportunities to talk to them. Occasionally I could speak to some patients in English, but my anxiety and mental fatigue didn’t help. As the days went by, I connected better with fellow patients and found a supportive group among them. On the other hand, I spoke to my psychiatrist once a week.
To address this issue, I would have appreciated having a cultural coordinator to assist non-Danish-speaking patients. A cultural coordinator could facilitate better integration and more frequent communication between patients and staff.
Another idea for improving integration is a program aimed at foreigners and volunteer Danish patients. In this program, Danish patients would host newcomers during the first days and help them by answering their questions. A cultural coordinator who creates personalized treatment plans considering our goals, preferences, and cultural backgrounds
Nutrition
It is important to emphasize the importance of a nutritious and balanced diet. Among other things, it is one of the factors for the patient’s recovery.
Additionally, a diet that does not repeat too often is appreciated so that patients do not become tired of the lack of variety and end up disliking it. There is room for improvement but, as with so many other things, it is just a question of budget and willingness to change.
I don’t have many complaints about the food during my stay. Of course, I would have liked to eat better but it would be unfair to say I had a bad diet. It was good enough. If anything, I missed more flexibility in meal times.
Families follow up
It is not only the patient who is struggling, but also the family can be burdened with stress and worry due to an uncertain situation. Good communication with the hospital is essential for the family.
My girlfriend was my only family in Copenhagen. She felt a little lonely and unprotected. During the first few weeks, she would have liked to have more contact with the staff and the psychiatrist.
A good initiative could be to conduct a follow-up program that includes the patient’s treatment plan, progress, and the steps being taken. Communication could be facilitated by email and be especially useful for occasions when relatives can not visit the patients. On the other hand, a support group could be created where the family can share their concerns and emotions with others in similar situations, such as other patients’ families.
Life after hospital
While writing this article, I realized the importance of two other issues related to my hospital stay. On one hand, I remembered the difficult process I went through before being admitted to the hospital. On the other hand, I thought of my life after leaving the hospital. A month later I got fired from my job. A few months later, I developed a cyclothymic disorder – rapid cycles of hypomanic and depression-anxious periods.
I will not detail my pre-post-hospitalization period, but I will point out some questions about the patient’s discharge.
After discharge, the patient is in a very vulnerable period. There is a high risk of relapse. During this time the patient needs the most support from the doctors and family.
Facilitate the transition to discharge through a continuous care plan, and involve the family in preparing the home environment.
The patient mustn’t feel alone when leaving the hospital. Support can be provided by maintaining contact with the psychiatrist, and attending therapy sessions or activities at the regional centres.
One big point of conflict is returning to work, or finding a new job. Companies and their employees need to be more trained about mental health issues. The more these situations are known and normalised, the safer space we will have. Some companies could count on a quota for employees with mental health issues. Having a diagnosis does not prevent you from working, but sometimes you need a boost, help, and conditions that suit you.
