Psychiatric hospitals: perception does not equal reality

by Cody Dolan on September 10, 2010 · 22 comments

in stigma

In this space I’ve made fun of Burger King. I’ve torn down Chuck. And I’ve taken aim at fictional universes. I’ve spent a lot of time telling you what the entertainment industry gets wrong when it comes to psychiatric clinics, but I’ve yet to show you how easy it would be to get these settings right…until now. [In my head here’s where I’d turn to the camera with a dramatic flourish, backed by an uplifting score. Since this is a text-based medium, please picture this in your own head. To help form this image, know that I look exactly like a younger, more handsome George Clooney.]

Let’s recap before moving on. This is what the set designer for House thinks a group therapy room looks like:

And this is what they think a patient room looks like:

Does that look like a place you’d want to spend any amount of time? I submit that it is not. Locked windows that are backed by wire mesh and look like prison bars. Institutional gray/sickly green walls. A bed that wouldn’t look out of place in an old war movie (the kind where the men are stationed in a big tent full of cots).  Irascible jerk who is mean to everyone…well, I suppose Dr. House wouldn’t be in your local psychiatric clinic.

These are two of the better pictures I could find. (Surprisingly, no one out there on the Internet is interested in posting photos of a fake psychiatric hospital that was on a show last September). Still, you get the idea; this is not a place anyone wants to be. Even if you knew you needed help and knew that this place could provide that help, there’s no way you’d voluntarily check in.

So what should the ideal psychiatric hospital look like?  I’m glad you asked.

Menninger

Here is a photo of a Menninger patient room, taken from the virtual tour available on our website:

Let’s just get this out of the way:

  1. The bedspreads may be straight out of the early 90s. We’d have to use carbon dating to be sure.
  2. The bulletin boards look like someone’s idea of a college dorm room.
  3. No one buys CDs any more.
  4. Do they still make boom boxes like that?

The accessories in the pictures are a little dated, but the floor layout and color scheme aren’t. These rooms have curtains. They’re carpeted. Everything isn’t pea green or beige. Patients get their own nightstand and desk and more than two colors are present. In short, it actually looks pleasant.

But what about other areas of The Clinic? Once again, I’m glad you asked. Here’s what amounts to a patient living room:

Now I’m biased because I once owned that exact couch (and no, I’m not kidding. I bought it at Gallery Furniture in Houston), but that looks pretty nice to me. I speak from experience when I say those couches may be the best napping couches ever made. In fact, I’m getting a little sleepy just looking at them. And no room is complete without pinto bean-shaped coffee tables.

Are patients allowed outside? Of course they are. And it’s a green wonderland of loveliness:

These living trees, green grass and paved walkways are a far cry from the tightly-fenced basketball courts, gravel paths and dead-leaf-strewn views you usually see on television.

Lots of shade, a comfy gazebo and covered walkways to provide some measure of relief for when it’s 107 degrees in August.

“I get it,” you say, “Menninger is awesome and we should all support it and give The Clinic tons of money for research and patient care and because it’ll make us feel good inside. But what about institutions not started by the Menninger family?” I’ve got you covered there as well.

Other facilities

Timberline Knolls Residential Treatment Center specializes in mood and eating disorders as well as addiction. It’s located in Illinois, near Chicago, and has an extensive website where anyone can view the photos below. Here’s an exterior view:

I am entirely comfortable admitting that this is nicer than the outside of my house. I want a porch like that, supported not just by wood joists, but by a huge column of stone. Nothing says class like stone pillars, and there are far too few of these things in my life.

Here’s the facility’s library:

Notice the comfy reading chair on the right. Once again, I want this in my house. That floor looks more comfortable than my couch.

Finally, here’s a patient room:

I don’t get the fascination with bulletin boards in patient rooms, but then I’m not a doctor. Still, this looks pretty A-OK to me. Collegial and cozy without trying too hard. Is that a spool of thread on the desk? I think I could get some knitting done in this room, so long as you don’t ask me to make anything that a normal human would wear.

“So you found one more nice place,” you say. “Big deal. I could find two places in Baghdad that make it look like it’s tolerable to live there.”

I’d respond by showing you the Austen Riggs Center, a well-known psychiatric clinic in western Massachusetts. Once again, I found all of these pictures on their website. Here’s a photo of a patient room. Sadly, it’s missing a bulletin board.

You get there by entering what looks like a colonial mansion:

Austen Riggs advertises an open, therapeutic environment with both inpatient and residential treatment programs. Patients there can use a “step down” program that helps them transition back to their everyday lives. Part of that transition means cooking meals in this kitchen:

I’m a terrible cook, and I’d jump at the chance to channel Gordon Ramsay here. Just look at that kitchen! I challenge you to comment below and truthfully tell me you aren’t in awe of it. It looks like it’s the size of my living room. (I should probably stop giving y’all the impression I live in a hovel.)

What’s the takeaway?

Psychiatric hospitals have come a long way since the 60s, but unfortunately that seems to be the last time anyone in charge of designing one for the big or small screen saw one. There’s nothing special about the rooms above; they all look like comfortable places people want to spend time in. Given that set designers create rooms like these all the time, it doesn’t seem like it’d be that hard to make psychiatric hospital settings look inviting, right?

Are you surprised to see how “normal” these rooms look? What were you expecting, and how could we work to combat those expectations? Let me know in the comments.

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{ 22 comments… read them below or add one }

Veronica August 11, 2013 at 3:07 pm

I have been hospitalized. Not at one or two but four different places. Two were bleak. One tried, but was still locked. The other was Riggs, as in Austen Riggs. I must say that upon looking back the grounds were lovely, the decor and rooms quaint. In the end, it doesn’t matter. I did not see or care about the activities (which were plentiful and diverse), barely participated in groups or therapy (offered from dawn til dusk, my doctor THE best – 4*week individual therapy). Chef prepared meals not eaten. Greenhouse unnoticed. Studio with pottery, weaving, photography & paint studio. I cared for nothing. Eventually the good, great places like Riggs help the lost one’s like myself care again. But this was no vacation. I am lucky Riggs stuck it out with me. Everyone else gave me up for lost.
There are places with bars. There are places with chefs. In the end money, insurance, quality of care, will to fight and the luck of the draw are what will decide the fate of the severely depressed. Sometimes ugly walls make us want to get better and go home sooner…..

Nicole May 11, 2013 at 3:16 pm

I’ve been on in four hospitals. None of them looked like the photos above. They didn’t look like house, but they most definitely looked like a hospital. Only one was free standing. Two let us outside. The outside at one of the places was a courtyard, and at the other was some grass and asphalt surrounded by barb wire. None were particularly unpleasant or dilapidated, but they all looked like hospitals and they were all quite clinical.

The pictures you are showing are more of top dollar residential treatment centers. I went to a much cheaper long term youth RTC ($300 a day vs $1000+ for the photos you show). It was more home like, but many of the rooms were basically falling apart, chipping paint, graffiti, etc. We lived in a communal dorm, one big room with 6-8 beds and a table in the middle. Our beds had screws that stuck out from them. There were other rooms in the facility our staff would check out for us to use, to watch a movie or play pool or whatever. We also had a very crowded dining room. There was a tiny library, a decent art room, a small gymnasium, and a nice sized fenced yard. But those were only used during school hours.

Carly July 2, 2012 at 9:59 pm

Most places look like the one House was in. I have been in several. Those that you have found are generally for longer term stays and are a lot more expensive. Furthermore insurance doesn’t cover very much of it. Believe me, if it did my parents would have dropped me off a long time ago.

lionsmakeyoubrave May 28, 2012 at 3:51 am

I’ve been hospitalized seven times in four different places; they all looked like the one House was in. The staff was horrible. The nurses were ugly and mean, and the psychiatrists were distant and strange and spent 2 minutes with me before prescribing me all different kinds of medications.

The therapists were condescending and seemed to all have anger issues. It was weird.

House’s hospital and my hospitals werent colorful and decorated like those fantasy ‘facilities’ you’re talking about but I liked it and I liked the simplicity.

I miss the hospitals…

you're wrong March 24, 2012 at 11:59 am

i’m not sure why you want to believe that mental hospitals are nice places to go, but they’re not. I was in a children’s psych ward and it was worse than House’s. The windows were covered with black wire mesh with graffiti carved into it that said things like “LET ME OUT” and “I WANT TO DIE.” We slept on cots, and some of the patients including me were made to drag our mattresses into the hallway to sleep. We were not allowed outside. We had several times a day where we were supposed to go watch videos or play with puzzles in the rec room on hard plastic chairs.

I really don’t understand wanting to cover up the truth like that.

Anne March 7, 2012 at 10:03 pm

I think this was a great article. It is really unfortunate how the media portrays the worst possible depiction of people with mental illnesses and the facilities that house those with mental disabilities. The pictures of these real life facilities look lovely, much more warm, and welcoming than most would ever imagine. While, I realize that every facility may not be as attractive as the ones shown above; I do think it is great that these facilities are even acknowledged for creating such a warm and inviting environment. The author of this article is right, the picture of the facility on House looks the complete opposite of inviting, and it certainly does not encourage anyone to check into it to receive help. It only makes sense that it is important for facilities that house those with mental disabilities to create a comfortable/inviting environment, after all people with mental illnesses are still human right? They have the same need to feel comfortable where they are living just as much as one without a mental illness. Hopefully, there will be a day when television and movies more accurately display facilities that house those with mental illnesses.

Dan H March 4, 2012 at 12:04 pm

So the article claims that TV is getting it wrong, only to have numerous people who’d know telling you that TV is in fact getting it right. Any chance of updating the article? Or do you still think that TV should be putting a bright face on real-world ugliness?

Stephina November 30, 2011 at 8:01 pm

Also, we were never allowed outside.

Stephina November 30, 2011 at 8:00 pm

when i was hospitalized, it looked like House’s hospital. The only real difference was that we had carpet, and our beds were way worse than the military ones. maybe it’s only like this in california…

shame on me shame on you November 15, 2011 at 4:12 pm

I (SPENT TIME) IN XENIA MEMORIAL HOSPITAL, MT. CARMEL, ST. ANN’S AND OSU. THE ROOMS WERE CLEANER THAN THE ABOVE DESCRIPTIONS. OF COURSE, THE WINDOWS HAD LOCKS (ALL PATIENT ROOMS HAVE THEM ON EVERY PATIENT ROOM WORLDWIDE). THE TREATMENT TOPICS WERE NOT OF USEFUL IMPORTANCE, BORING, SHORT AND VERY STRESSFUL. THE TALKS WITH THE (1) PSYCHE WAS ONLY 5-10 MINUTES. HE ONLY ASKED ME, “HOW ARE YOU FEELING TODAY ?” OF COURSE I SAID, “FINE.”

THAT’S THE GEST OF IT. OH, WE WERE LET OUTSIDE, AS THE SMOKERS (THEY HAD A RIGHT TO BE OUTSIDE). OH, WE HAD AN HOUR, TWICE A WEEK, TO GO TO THE RECREATION ROOM AND LEARN/MAKE CRAFTS. NOT TOO AWFUL, JUST NO REAL HELP TO ME.

Lisa Blount July 25, 2011 at 3:21 am

The only public place to go where I live is the Ruth Cooper Center in Fort Myers, Florida and it makes these places look like not five star hotels, but palaces. When you arrive you get to go into a holding cell – a sort of waiting room until the beds (really cots – with no real pillows) are available. It is freezing cold. The lights are on in the holding cells 24/7. The holding cell is just a small enclosed area with a hard bench. You cannot sleep on it, it’s too small. They do give you a loose woven blanket (you can’t kill yourself with it) but no pillow (you’d kill yourself with it they think). It’s a little better than jail but not much. Interior design is not even in their minds. “Safety” is. Florida is number 49 in the nation for mental health funding. This place is so “safe” it might kill you – no kidding.

Guest March 16, 2011 at 11:18 pm

When it happened to me, the place was further from the nice rich hospitals than the one in Dr.House. That guy is actually wearing his own clothes, we had to wear hospital gowns.

We were given 3 meals a day, could change our drapes, gowns and take our showers whenever we felt like it, so theres nothing to complain about, except maybe that the only way we could go outside was on a wire-fenced balcony with a cement roof, but we didn’t have our shoes anyway. I think it was alright and more than that would be wasting money.

Wow March 9, 2011 at 6:37 pm

I just looked more closely into these. These are rehab centers, not psych units or mental hospitals. People with bipolar, aspergers, schizoaffective/phrenia, ect do not go to places like these. Rich people like Eddie Van Halen do.

Wow March 9, 2011 at 6:33 pm

I’ve been in 4 psych units in my life and 1 state mental hospital (Hawthorne center in Livonia) in my life and none of them were anywhere near like this. I have no idea where you got those pictures, maybe it’s a private hospital for rich people or something. Hawthorne was like a college dorm with air mattresses (more like gym mats), hallways that led to more hallways, a TV room and a rec room. All of the others were about the same except with hospital beds and not air mattresses. In all but two places that had bulletin boards they didn’t let us put anything on the walls or have any writing utensils outside of the rec room. In two of the places we weren’t allowed personal belongings in our rooms that didn’t come from the place itself because of the risk of people sneaking in drugs or weapons in pillows or stuffed animals or even LSD on paper so everything from books to bedding had to come from inside the unit. The staff were most often either apathetic or coercive, sometimes violent. Everybody was drugged up so badly it wasn’t uncommon to be stepping on drool, seriously. 4 of my experiences were when I was a child only one as an adult and the adult place was by and far worse. I sincerely doubt there is any truth in your perception of what psych units and mental hospitals look like.

Joe February 28, 2011 at 1:06 pm

Perhaps rather than showing pictures of the interiors and exteriors of dedicated psych hospitals, you could show the interiors and exteriors of psych units located inside general hospitals. The one I worked in had more in common with the House pictures you showed than the gorgeous pictures that followed – it was complete with window barriers, a weedy lawn that was half-dirt, half-weeds and was surrounded by a beautiful, ancient chain-link fence overgrown with weedy vines… and patients were allowed to visit this botanical paradise once per day and only if they did certain things as asked by the nurses and aides. If they did not do these specific things, they were not allowed outside. I always thought this was strange since being outside is a great way to alleviate depression. But I don’t think alleviating illness factored into that particular form of coercion. I think it had more to do with staff convenience.

The rooms on this unit had lovely beds with wood bases that looked as though they had been created to fulfill the requirements of a community service project for a high school shop class (if they still have those classes). There were no chairs in the rooms, so if patients wanted to read, they had to sit in their beds and lean up against a wall. Very comfortable, I’m sure. The doctors and nurses either stood, or if there was no roommate, they could sit on the other bed in the room.

The community room, was dirty and had uncomfortable plastic chairs and cheap fold-out tables. There was one TV in the community room for everyone to fight over. There were no TVs in the patients’ rooms. The rooms had tiny closets and tiny showers.

The nurse’s station was cramped, overflowing with “stuff” and had a desk that looked like the base of the beds in the rooms (shop class volunteer project). The paint in the patient rooms was drab. The carpeting looked old, very thin and dirty. The bedding was the same generic, lifeless stuff you find in an ER. And I’m not sure where this 1-hour assessment idea comes from, but the doctors in that unit saw people for about 5-10 minutes and then moved on to the next lucky customer. While House might not have been right on the money, in my experience, the show’s depiction was closer to reality than what you show above – although I wish that were not the case.

Guest commentator February 3, 2011 at 10:54 am

Having worked in a few different psychiatric hospitals I will say there is a vast variety of envirnoments among psych facilities. Your state hospitals definitely don’t reflect the pictures above. I do wish the world of inpatient care would move more in the direction of comfort without compromising safety but unfortunately safety is often (and should be) the primary concern. I can only imagine how much more psychologicaly healthy patients would feel if their surroundings felt pleasant and comfortable even though inside they didn’t.

Meagan R. January 7, 2011 at 5:09 am

haha, I was at Timberline Knolls for a few months this year, and I was looking at that picture like “Huh? Where is that?” then I totally recognized it. BTW though, the library is not all that impressive. And the patient rooms don’t look exactly like that, but they are equally lovely.

The bulletin board thing is kind of funny though, because no treatment center is going to give you tacks. Instead, they have those ribbon memo boards. Much safer.

Timberline was breathtaking, especially in the snow and ice. The doctors and staff there saved my life.

Emily September 23, 2010 at 2:20 pm

Ummm…my experience in ’93 didn’t look anything like that. The windows were blacked over, which the nurses claimed was a mistake, but I happened to peek in an office where you could see outside. Mistake…sure. There was a big room with a table where all the smokers sat. That’s probably gone. The therapy room looked a bit like a living room, the way a hospital waiting room looks like a living room. The bedrooms looked liked hospital rooms. That’s what they were. There was another “Common Area” with a very small TV, a table for eating, lots of metal chairs, and puzzles with multiple pieces missing. I was there for almost 3 months, and during that time period, I and a few other patients were “rewarded” with a trip outside to a nearby park, where I was forced to throw the damn softball back and forth whether I wanted to or not because I didn’t know what was good for me. I’ve had more than one psychiatrist try to trick me into making the mistake of admitting suicidal thoughts, which I deftly avoided. If I’d known I was going to get a vacation at Shady Acres, maybe I would have caved.

pacificpsych September 16, 2010 at 12:03 pm

I just saw that episode on DVD and it irritated me greatly. The ‘patients as buffoons theme’. The doctors who hang around the unit and do group therapy. Yeah, right. The director who does psychodynamic therapy. Yeah…riiight…and takes his patient out for an evening out. With drinks. Give. Me. A break. LOL. maybe this still happens at Menninger (well, not the drinks part), but I can assure you this is pure fantasy when it comes to the rest of the psychiatric hospitals out there.

As for appearances. I’ve worked in several hospitals that belong to a large, wealthy and profitable corporation. They have brochures lying around to prove this, showing how much profit they’ve made. These hospitals were disgusting. Filthy. F-i-l-t-h-y. Doctors either had no office or were given some room with a moldy carpet that doubled as a storage room. The units – INCLUDING the children’s ward — were bare. Grim. Dark. Half basement. Windows were not only locked they were shuttered. Couldn’t open the shutters to let in any light.

No decorations. No plants. Patents crammed into every room. Assessments had to be done STANDING UP In the patient’s room because there was nowhere to sit and do them. That’s an hour of standing for the doctor. Fun, huh?

The only nice places in these hospitals were the offices of the CEO, CFO and their secretary. Plush leather chairs, nice new computers. Did I mention there were NO computers in these hospitals for the medical personnel to use?

Patients are locked in and are herded out a few times a day for smoke breaks. BTW, many patients choose to come to these hospitals because unlike other hospitals they can smoke there.

Please don’t think that those few gems you show here represent in any way the grim reality out there.

Portia September 13, 2010 at 5:54 am

Just a heads up that Menninger recently repainted most of the PIC unit pea green. It’s pretty Classic Mental Hospital.

As a former patient, I’ll say this: the staff was world class, but the decor was not. Those pictures above don’t do it justice. The furniture is old and shabby. The mattresses are little more than overstuffed gym mats (although these were scheduled to be replaced this summer), and the bed frames have holes to string restraints. (Not that they’re ever used but, you know, they’re there to remind you they can be.) The windows are retrofitted with bolts and locks. The bulletin boards are giant Post-Its because you can’t have thumb tacks. The mirrors are unbreakable. There are no rods (e.g., curtain, shower) on which to hang anything (including yourself), and you’re not allowed anything with a cord.

Again, it’s all pretty Classic Mental Hospital.

It’s not JAIL, but for twelve hundred dollars day you wouldn’t expect it’d be, right?

Not that I’m complaining. Like I said, the professional staff more than made up for what the environs lacked. (And the food was okay, too.) Just … you know, don’t oversell it based on some brochure photos.

Mary September 11, 2010 at 5:27 pm

I think I am in love with this article. Sarcasm and truth together with showing people what is right and what should be are especially great. It’s about time Hollywood gets it right, but then who would watch? We are all attracted to the worse possible scenerio in every situation.

Chrysalis September 11, 2010 at 10:55 am

Wow. These are *amazing*. I was shocked at, not just how normal, but how beautiful, these are! Definitely not what I was expecting.

What was I expecting? Well, I’ve spent time in the (public) psychiatric ward at two different hospitals and so I was expecting more like that! The psychiatric ward of my usual hospital was… not much different to the rest of the hospital, in a lot of ways. The predominant colour was white. We had curtains – but they were the same pull around the bed curtains you see in the other hospital wards. The beds more closely resembled the House psychiatric bed than the lovely ones you’ve got pictures of! There was a communal lounge, but it was a small, square room and the VCR had not been replaced after it was stolen/broken. Outside was quite nice, except for all the smokers’ mess and the smoke from the smokers. There was no library and my ward didn’t even have a games cupboard, though there was a communal activities room available from 10 – 4, Monday through Friday.

All that said, I do love the public health system here, but I’m very jealous of these beautiful places to recuperate in!

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