What I found most interesting was found in the Grubaugh, et al. article especially in contrast to the Hunter, et al. article. In the former, the patients' perceptions of safety in hospital facilities was frightening. The statistics that stood out the most were those of being handcuffed, as well as " being placed in seclusion (59.6%), being put in restraints (34.0%), receiving a “take down” (i.e., subdued by physical force; 29.1%), being forced to take medications against wishes (27.0%), being strip searched (24.1%)". Those numbers seem incomprehensibly high. I realize in this setting, we are dealing with very symptomatic patients with severe mental illness, however, seclusion, restraints and strip searching seem inhumane. I found the study on Gary to be rather promising. Instead of just following protocol, they figured out some of his mood issues might have been from medication withdrawal and they seemed to have great success in behavior modification and self-soothing through means that weren't coercive and harsh as mentioned in the first article.

For me, the challenge to working in a psychiatric hospital seems to be the severity of symptoms and risk of harm to themselves or others, and the treatment that those require. As one of the required readings mentioned, the number one reason for hospitalization is suicide. According to another study, as referenced in my previous response, the means by which they keep patients "safe" aren't necessarily ones that I could endorse. They also seem to follow more of a medical model of diagnose and treat (usually with medication). I think of myself as more of a "talk" therapist, rather than someone that deals in medication and/or safety patrol.

Even before I began my practicum, I saw myself in a Community Mental Health Center setting or private practice. While I know a lot more now about other options that are out there, I think that knowledge has more or less solidified the fact that I still see myself in private practice or at a CMHC. Having said that, I am open to other experiences. I simply enjoy the variety of working in the community and with several different populations as I do at my practicum. I think I would burn out much more quickly if I was stuck with one population or modality day in and day out. At my CMHC I use play therapy, do home visits with older adults, run a DV mens group as well as perform traditional individual therapy. I think my niche is just variety and I seem to have found it there