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What are the important points to remember working as a new clinical mental health intern at an inpatient/outpatient hospital unit?

Hi all, I'm a second year grad student in mental health counseling, and first year intern. I was wondering what are the important points to remember working as a new clinical mental health intern at an inpatient/outpatient hospital unit? Do you have any tips that would ease the anxiety of not knowing what to expect?

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Michelle’s Answer

Hello, Niloofar !

This is a very admirable and altruistic experience that you are embarking on and so needed. I do hope that as part of your internship you will be able to do direct services with the patients and use everything you have learned so far. You will be encountering so many various types of patients and they will actually teach you about mental health, greatly enhancing your understanding and the education you have so far.

So, you are asking for tips. With the in-patient experience, you can expect a typical Behavioral Health Unit to be highly secure. Doors are locked and you should always check with your supervisor for approval of any action or duty that you do. Some in patient units are very homey, relaxed and comfortable, but depending on the hospital, some are not, and can be noisy with lots of activity. You'll need to know how to adjust by shutting noises - and sometimes odors - off and just focus on the work. Try to tell your supervisor that you want to do as much hands on work as possible - keep busy. Maybe ask if you can do intakes and light counseling, keeping a patient company or engage in an activity like a game, cards or whatever the facility has available, following their protocol. Like I said, this is totally going to depend on the particular place you intern at.

If you have not worked in the mental health field as yet, you will have to get used to the homeless population and others which can be very resistant, physically challenged, unkept and unclean (not all populations are like this, though). This takes a bit of getting used to but you will learn how. Sharpen your skills of persuasion as many of that population refuse services . But most importantly, meet the patient where they are at. Do not try to change the person. All patients need compassion, understanding and acceptance and they need to feel that. It really does get better as you progress in the field year after year.

You will see many successes but you will also see many downhill slides in the patients. Do not take it to heart. Just having you there really does make a difference and you should never forget that. Everyone is an individual and makes their own choices for various reasons and all you can do is offer your expertise, services and validation to the patients.

At first, there may be some anxious feelings about who is going to be coming in next. You will deal with everything from A to Z. Ask your supervisor if there are ever any in-services that you could/should attend as far as security, safety or any others that your facility will have. It will be very important to attend these. Try not to worry and let things flow naturally. Make time for some fun outside of work.

I do wish you all the best in your internship. You will learn an enormous amount and go forward with a career that you truly love !
Thank you comment icon Hi Michelle, Let me just say how much I appreciate your response. The following statements stuck with me, "All patients need compassion, understanding and acceptance and they need to feel that." As well as, "Try not to worry and let things flow naturally." This is what I hope to let grow. I'm tearful in hearing that my presence and later on skills can potentially offer goodness. Thanks again for sharing your experiences. My best regards, Niloofar Niloofar
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Kira’s Answer

Hi Niloofar,

I want to add a brief response to all the information given in the previous 2 answers. I also give you a lot of respect for choosing work that can be challenging and so helpful at the same time.

One piece of advice is that if you can convey to the patients that nothing is wrong with them; that though their behavior may not be acceptable in the moment, that it is still logical and natural given everything that they've been through in life. That their behavior is not a character flaw. And even more so, that they deserve admiration and respect for surviving their challenges thus far.

No matter how you actually feel about the patient in the moment, if you can impart this likely accurate perspective to them, it could foster a more peaceful environment for them - and for you too.
Thank you comment icon Hi Kira, What a wonderful piece of advice!!! I can imagine how the following statement would invite acceptance, openness, and space in any therapeutic setting, "...if you can convey to the patients that nothing is wrong with them." I also agree that our approach to patients will impact our attitudes and reprogram our minds to see the gritty person beyond the challenges. Thanks a lot for your wisdom! I agree with you about fostering peace between us through mutual respect, or more so, bringing respect to the space. I think that unbiased approach will lead to a more trusting and peaceful environment. My best regards, Niloofar Niloofar
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Michelle’s Answer

Hello Niloofar,

I have over 20 years of experience in various mental health settings, such as inpatient care, homeless shelters, outpatient and intensive outpatient care. Here are a few key pieces of advice I usually share with my interns, and I'm sure your supervisor will have plenty more:

- Don't hesitate to ask questions; there's no such thing as a dumb question.
- Maintain boundaries with your patients.
- Be respectful.
- Set limits when needed (this one takes some practice).
- Always remember that many of your patients may have experienced trauma.
- Understand that the same diagnosis can result in different symptoms or presentations; it's not a one-size-fits-all scenario.

In the inpatient units where I've worked, patients either have their own bedrooms or share with others. Typically, there's a shared space with a TV and various activities, along with one or more nursing stations. Group therapy sessions are usually conducted throughout the day. I've always found working in inpatient care rewarding. It can be nerve-wracking when you're unsure of what to expect, but you'll adapt quickly.

In outpatient care, patients are generally less severely ill. They are not considered a risk to themselves or others and can take better care of themselves.

I'm confident you'll receive a comprehensive orientation where you'll learn the rules of the unit, safety procedures, privacy maintenance, and more. Best of luck to you! Welcome to the world of mental health care!
Thank you comment icon Hi Michelle, Thank you for offering clinical perspectives to my question! I agree with you about the possibility of the experience "be[ing] nerve-wracking when you're unsure of what to expect, but you'll adapt quickly." It's so helpful to know that diagnosis result in diverse behaviors in different patients. I also appreciate you offering a visual image of what to expect at an inpatient ward. Yes, as of now I have received violence Prevention training and a hospital orientation. Then it's a matter of how long it'll take me to adapt. Tomorrow (or technically today) is my first day as an intern and I look forward to it. Thanks again! My best regards, Niloofar Niloofar
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Judith-Ann’s Answer

Niloofar, congratulations on your studies thus far. I agree with everything Michelle has generously presented to you. Most of my career has been in a private practice with individuals, couples, and families. I spent one year in a clinical setting such as where you are right now. The clients were difficult for me. I did not get to experience quality one on one counseling as I had hoped. Each individual session felt forced and non productive to me. The group sessions designed for trust building and communication were very challenging as many of the patients were disruptive and non compliant to the rules of group safety. Like Michelle mentioned in her letter to you, the clients were homeless, or manic, or emotionally debilitated or court ordered. It was a challenge to keep order. At the end of the day, I had to write up charts in which observations and progress were to be reported. Many times, these reports had me in tears. Charts are required by the state and by the insurance companies.

For me, I was disappointed in the service I provided. Many times I felt like I was just a body filling up space. I felt I wasn't fulfilling my purpose to help people, to be there for them in their most vulnerable states. Like Michelle said I had to remember that being there for them was my purpose. Maybe they were working on the first level of Maslow's hierarchy of needs, maybe the second. I wanted to work on the self actualization level and I had no idea how to get these patients to that level because they needed social services, financial stability, friendships. I had to believe that a loving nonjudgmental presence was important to them. I had to spend much time in prayer and meditation for myself to keep going, to believe there was hope for the patients, to remember what they needed was so much bigger than what I could give by myself. I had to keep very strong boundaries of professionalism. I had to not move that boundary into a friend role as that is very harmful for the patient. I had to hold on to my hope for them.

So Niloofar, I do believe that it is a calling to work in a clinical setting and I admire the clinicians who fulfill their purpose there. I trust you will find your purpose and learn so much along the way. Let the adventure begin! And never loose your sense of humor!
Thank you comment icon Hi Judith-Ann, I appreciate hearing about your experience so much!!! Thank you for so vulnerably and yet poignantly sharing the hard work, disappointments, and challenges in the work with this population. The following stood out to me, "I had to believe that a loving nonjudgmental presence was important to them," and "...to remember what they needed was so much bigger than what I could give by myself." In addition to that, I appreciate your reminder of Maslow's theory as it makes so much sense. This reminds me of "meet them where they are at" which appears to be a reoccurring theme in therapy work. Thank you so much!! My best regards, Niloofar Niloofar
Thank you comment icon Niloofar, You are so welcome and I appreciate your reaching back to me. Feedback is helpful for me as well. I wish you well and send you good thoughts. Judith-Ann Anderson
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