The prestigious McLean Hospital is located in Belmont, Massachusetts, but also has connections to the Franciscan Children's Hospital in Brighton. McLean runs Unit One at Franciscan's, a psychiatric ward that houses roughly 20 at-risk teeangers and a few children in the latency section. Unit One follows the same schedule and system as the main McLean campus. The two main similarities:
1. The Point System
Every patient is graded, per se, by "mental health specialists", aka residential counselors, based on nearly every daily activity. Everything from lunch to taking a shower is included when distributing points. At the end of the day, the points are tallied off to determine what "level" the patient is at. Higher levels have more freedoms, such as a trip to the snack machine or gym, whereas lower levels mean an earlier bedtime and so on. Patients lose points for misbehaving, not following the daily routines, etc.
Multiple group therapy sessions are run each day and referred to as "group". They are run by the counselors, psychologists, and sometimes by visiting psychiatry students. Every morning there is a check-in group where patients are asked to rate their mood on a scale of 1 to 10, set a few goals for the day, etc. When new patients arrive, they introduce themselves at check in and reveal basic information such as where they're from and why they're there.
Almost every person who has been a patient at both the main McLean campus and Unit One will tell you that the staff is exponentially better at Unit One. They are notorious among the Boston area psychiatric wards as the kindest and best staff. It should be noted that "mental health specialists", which is their official title, are basically the people that watch the patients, conduct groups, and make sure they are supervised, and do not need to have any degrees or credentials in psychology, as it is an entry level job, although experience in pediatrics is much preferred. In addition to MHWs, patients are in contact with their case worker, psychiatrist, psychologist, and nurses. Because virtually anyone can apply to be a MHS, they get very, very little, and are not always qualified to be a caretaker of such at risk adolescents.
Because Unit One is specifically designed for people who are dangerous either to themselves or others, security is tight. Virtually anything that could be used to hurt yourself or someone else is banned. Bars of soap, belts, pencils, spiral notebooks, and jewelry of any form as some of the items marked as contraband. In addition to this, whispering, sharing things, passing notes, and physical contact are all not allowed in an effort to reduce the possible conflicts that could arise.
A basic schedule of a patient at Unit One would be as follows:
7:00am- wake up call: patients bathe, dress, and make their beds.
8:00am- breakfast: a hospital worker brings a trolley, and patients are allowed to choose two items. The trolley is always stocked with yoghurt and cereal, and occasionally has other breakfast foods.
8:30am- Check in group
9:30am- School/Life skills: Half the patients go to 'school', the other half to 'life skills'. They will alternate later. In life skills, patients usually do creative activities, such as coloring or drawing. During school, patients work on individual projects that they determine with the teacher.
10:30am- Snack time!
11:00am- alternate: either school or life skills.
After lunch, there will be groups, free time, snack, more groups, afternoon check-in, and then dinner. After dinner many students opt to go to bed, while other hang out in the dayroom. Depending on what level you are, bedtimes range from 8:00 to 9:30.
Patients may sleep in until 10am. Because access to bedrooms is restricted, as patients must be monitored at all times, most of the day is spent in the dayroom. Staff will sometimes bring in a movie. If there is time and enough demand, people on a high enough level sometimes get field trips to the computer room, snack machine, or gym.
Throughout their stay at Unit One, patients are treated with psychotherapy as well as pharmacotherapy. One of the first things a doctor will do upon a patient's arrival is assign them a medication. As it is an adolescent ward, only two people can control whether or not a patient may leave: the doctor, or the patient's legal guardian. The next logical step in treatment is to send the patient to a step down facility, which is a less secure unit. Many of the patients will be sent to East House at the main McLean hospital. The average stay of a patient at Unit One is two weeks, however there are extreme cases of patients staying there for up to six months.