Personal luxuries permitted within a psychiatric unit.

Books, magazines, etc. are allowed. Anything is allowed that couldn't be used to hurt the self or someone else, or that might get stolen. Units don't want to be responsible for replacing valuable things. Phone calls are allowed unless there's a reason not to allow them. Generally there aren't phones in the patients' rooms though, so they use the group phone, and calls are limited in time allowed on them, and in times when they can be used (not during groups). Unless there's a reason not to, physical activities are planned. Lots of psych units have gyms the patients can go to, with staff. There's generally and art, music, and occupational therapist, or someone else provides those activities. Some patients, for whom it wouldn't be a problem, might go outside for fresh air and its opposite, smoking.

Most places don't permit things like MP3 players, Walkmen, boomboxes, that sort of thing (cords/wires are a safety problem, plus the facility doesn't want to have to replace them if anything happens to them). Reading material is fine. There is usually at least one TV in a public area on the unit (in addition to Whispera's note that rooms don't have individual phones, client rooms on psych units also don't have TVs).

People can usually use their home toiletries as long as they're in plastic bottles/jars. No glass containers, no razors or scissors. No medication (Rx or over-the-counter) that isn't prescribed by the treating physician/NP at the facility and administered by the staff.

There is usually a pretty full schedule of various therapeutic and recreational activities during the day/evening, and not a great deal of free time -- it's not like being in a "regular" hospital, where you lie in bed all day in pajamas or a gown; it's more like going away to camp, if you will. Most places prefer to involve family members and significant others in treatment if that is appropriate (and the client is agreeable).

People don't have to participate in therapy. If family is unable or doesn't want to be involved, or the patient doesn't want to involve them, they aren't involved. Recreational activities can be all sorts of things! exercise, basketball, line-dancing, cooking...

Soft drinks are allowed, but caffeine is discouraged. Care packages and letters are searched for dangerous items and then given to the patient if appropriate (Letters are always given unless there's an order that they can't be given to the patient, but staff has to make sure nothing else, that could be dangerous, is in the envelope. You'd be surprised what people send to patients.) They can keep a minimal amount of cash or change with them.

Patients have the right to refuse medication unless their behavior is out of control and threatens others, themselves, or property, or unless there is a court order that medications can be given.

Why are you asking all these questions? I'm curious...

Caffeine isn't discouraged just because it's unhealthy---it's discouraged mostly because it interferes with psych meds. In my experience a patient can have caffeine if the doctor orders it. Otherwise drinks on the patients' trays are decaf.

No, their stay isn't lengthened if they refuse to participate in therapy, although sometimes it's difficult to see how they're doing if they won't do anything.

Staff does not read letters or other mail before giving it to patients--they just make sure there's nothing dangerous in the envelope. By appropriate, I meant not containing razor blades, cocaine, marijuana, or other things that shouldn't be there (and they ARE sent/brought to patients. I once had a visitor bring vicodin into the unit in an altoids tin).

I don't imagine porn would be allowed. It never was an issue where I worked. Generally patients are given a list of things they can't bring in or have brought in for them, when they're admitted.

By threatening themselves, I mean trying to hurt or kill themselves. People do that when hospitalized in psych units.

I still wonder why you're asking these questions....

Often, it depends on the acuity of the facility and the facility itself. For example, a locked adolescent unit for adolescents who were a risk to themselves/others did not permit shoelaces or draw strings in pants, MP3 players (they required headphones, which are on a string), no pens (had to be used under supervision, again, dangerous.) The girls shaved their legs with supervision from a staff member in the bathroom. Basically, anything that posed a risk was contraband.

However, try a stand alone acute care psychiatric facility with voluntary patients. These patients are typically entitled to anything they want/need unless they are specifically posing a risk to themselves with that item. For example someone with a history of self-harm may keep their shaving gear locked up in the nurses station and request it when feeling safe enough to use it, which the nurse will assess and make a call on. It's a way of encouraging safety and independence in less acute patients who are learning to manage their illnesses.

Interestingly, in the US a lot of treatment centers for eating disorders (large, stand alone residential facilities for the most part - like Remuda Ranch, Center for Change, Magnolia Creek etc) won't allow fashion and women's magazines (by the theory that they don't promote healthy body image and self-esteem and therefore inhibit recovery), won't allow cell phones (variety of purposes and someone only have designated phone time on the public phones, which, some centers need you to earn), I know that Remuda Ranch only allows Christian music and literature. A lot of these facilities also prohibit laptops/computer time (or it has to be earned and supervised - largely to avoid distraction from recovery and visiting "pro-ana" websites.) Some of these facilities even have restrictions on what clothing can be worn - at Reumda I understand that no flip flops are allowed (due to being in the desert/snakes or something?) & at Center for Change no baggy or loose fitting clothing is allowed (to encourage the patients not to hide their bodies underneath clothing.)

Each center differs on the patient needs.

On the unit where I worked we didn't allow patients to carry cash. Any cash or valuables they brought in were inventoried and put into the safe by security and returned upon discharge. We allowed soft drinks (in fact we provided them), but they could not be in aluminum cans (because the cans could be torn open and the edge is very sharp). Anything brought in by a visitor or friend was checked by the staff and any unauthorized items were sent back with the visitor when they left. We did not restrict letters. Generally speaking, our patients were not on the unit long enough to get much in the way of mail.

If a patient doesn't want to participate in therapy or recreational activities, they don't want to take meds, and the family is not involved, what would be the point of an inpatient stay?

If it's a matter of providing safety until harmful thinking passes, they would probably have a very short stay followed by outpatient treatment.

Other than wishing to stay safe, people usually enter an inpatient unit because something really isn't working for them. Meds need to be started or changed or adjusted. Or they need to temporarily step away a toxic environment. Or out patient therapy has not proved extensive or intense enough to get to the real issues.

For someone whose life isn't functioning the way they want, the logical next step is to try something new. Coming into an inpatient setting with hesitation is understandable, but I think there has to be a recognition that participation is an important step in developing trust and getting unstuck. It may not be fun. The activities may not be things the patient would choose on her own, but the familiar can keep one mired in a soothing, but deceptive trap.

The very act of entering into unfamiliar territory stirs up emotions and heightens awareness. Obviously, people don't want to do this in a setting that is unkind or uncaring. But even the most proficient unit with the best treatment and the highest success rate will feel scary and even hugely uncomfortable in the beginning.

I would advise anyone considering inpatient treatment to research as much as possible about the facility, the practitioners and the treatment methods. And then, having selected one that seems trustworthy, enter in with the knowledge that nothing is going to feel good or normal initially. Trying to gather and hang onto as many creature comforts and defense mechanisms as possible can actually prolong the process.

I'm not suggesting that a patient should be doused with cold water or stripped of all pleasures. But there needs to be a balance between feeling safe and feeling challenged in a healthy way. Trying to recreate the status quo is counter-productive. If the status quo was working so well, there wouldn't be a need for inpatient treatment.

Again, this can feel awful. Having to examine dysfunctional thoughts and beliefs or answer to others in a group session can shake a person to the core. But the old has to be exposed and dismantled before the new can come in. It's like a detoxing of the spirit. Or the washing off of deeply embedded grime. Hard, even painful, but invigorating.

For many, the giving up things they want and doing things they don't want to do will make them angry. Very angry. This, too, is part of the process. So much of depression is rooted in misdirected anger. Other diagnoses encompass anger issues, as well. Staff members are aware that "pesky rules and requirements" can infuriate patients and, to some extent, this is a welcome reaction. Not because they're sadistic, but because patients often come in with layers upon layers of repressed "stuff" that needs to be hauled out into the cold light of day. Nothing like a good old-fashioned temper tantrum over phone privileges to strip away the veneer of niceness that so many of us wear. Then the real work can begin.

As for the exercise and other activities, this might sound silly, but in animals (humans among them) physical activity influences the thought process. In part, it's the action of getting the blood circulating and making the synapses jump and fire. But it's also moving forward, finding rhythm, reconnecting body and mind. Many people with depression or other thought disturbances are either at war with their bodies or they have become so numb they no longer know what they feel. The simple act of going for a walk is a gentle but powerful way of reintegrating the physical and the emotional selves.

Entering inpatient treatment is a big step and one that shouldn't be taken lightly. But so much good can come of it if the patient is willing to venture outside their literal comfort zone and enter in with a spirit of courage and hope. Regulations that seem childish and over-controlling can be the very provocations that help a person become real. Many patients who hated a program when they entered it have cried when it was time to go because they became so invested in the recovery they found there.

And some of them go on to become the staff members of the future.