Hospital psychiatric wards under scrutiny

HARTFORD — New safety standards aimed at limiting suicide risks have led to overhauls inside hospitals around the country, with psychiatric facilities and wards removing bathroom doors, stripping artwork from walls and requiring patients to wear paper gowns instead of their own clothes.

The changes have forced costly renovations and caused a backlash, with some critics contending they’ve made hospital rooms feel more like jail cells.

Regulators say the new guidelines leave room to protect patient dignity and privacy, but many hospital officials tasked with updating facilities and their procedures say they’ve gone too far.

“I think we are moving toward a very prisonlike system,” said Patricia Rehmer, president of the Behavioral Health Network for Hartford HealthCare, which operates Hartford Hospital. “We try and make it comfortable, we try and have as many things available as we can, but it’s not easy.”

New suicide prevention requirements took effect on July 1 on orders of The Joint Commission, an agency that works with the Centers for Medicaid and Medicare Services and accredits the vast majority of the country’s psychiatric hospitals.

A 2018 report by The Joint Commission Journal on Quality and Patient Safety found an estimated 49 to 65 hospital suicides happen annually. The report was described as the first datadriven estimate of inpatient suicides per year in hospitals.

In general, now pictures cannot be hung on walls, doors on bathrooms are either removed or replaced with polystyrene foam doors, and remotes are removed for televisions that are now secured behind plastic glass. Ceiling tiles and door handles must be replaced with riskresistant ones, along with special types of beds and sheets.

“We’re buying the same furniture and plumbing fixtures as prisons and jails,” said Dr. Bruce Schwartz, president of the American Psychiatric Association, adding that the requirements are creating harsher environments in psychiatric facilities.

Several organizations with the Michigan Health and Hospital Association have struggled to comply with the new requirements in the timeframe expected by The Joint Commission, said Laura Appel, the association’s senior vice president and chief innovation officer. She said empty rooms may be safer but they’re also significantly less comfortable.

“The lack of doors means an insult to patient privacy,” she said.

Michaela Fissel, executive director of Advocacy Unlimited, said hospitals could make the settings more homelike and comfortable by adding yoga or music and letting patients wear their own clothes instead of a paper garment.