Balancing Empathy and Efficiency: Navigating Crisis Stabilization Treatment at Holly Hill with Hailey Baldwin

“Honey, take the Ativan!” This was the most salient request coming through the chaos of shuffling feet and crowding bodies and beeping machines as a Holly Hill patient laid on the ground by the med window, convulsing and crying, presumably having an anxiety attack. She was refusing the medicine, trying to write her requests and feelings on a piece of paper because she was hard of hearing and temporarily mute amidst the panic and stress. The Holly Hill staff, finding her vitals to be relatively stable and unable to offer much more assistance after the refusal of medication, helped her into a chair in a separate room where she continued to quietly cry and shudder. Concerned, I sat beside her and offered a breathing exercise; she instead requested company walking around to process what she was feeling. For the next half hour, I walked beside her up and down the unit hallways, listening and chatting about her dear young daughter at home and sweet anecdotes she wanted to share. Throughout the course of the conversation, her demeanor improved dramatically, and by the time I was called to help with a therapist’s task, she was in great spirits, laughing and calm. The entire incident stood out to me as a demonstration of the importance of holistic mental illness treatment; sometimes a person needs an empathetic listening ear and not just medication.  

Though Holly Hill serves an important niche in mental health care of short-term crisis stabilization, its structure is limited in its ability to help people in the capacity they often need. The average stay at Holly Hill is 7-10 days, a quick turnaround that emphasizes efficiency in treatment, typically centered around medication administration and management and physical safety, which theoretically facilitates a return to the patient’s baseline. Patients are seen by a diverse treatment team, each with a therapist, doctor, nurse, and mental health technician. The therapists, either Licensed Clinical Social Workers or Licensed Clinical Mental Health Counselors, are tasked with a case load of 14-30 patients depending on the acuteness of the unit. While coined “therapists,” their primary task is case management, and they are responsible for a hefty load of duties for every patient in their unit. On top of running one group therapy session each day, they must handle the admission assessment, be a point of contact with family members or friends, manage discharge procedures and secure long-term housing or treatment options as well as a means of transportation to get there, and administering admission, discharge, and satisfaction surveys to each patient. Within this demanding schedule, there is little space for addressing specific patient needs and giving ample time and care to patient requests. The psychiatrists or nurse practitioners assess each patient and prescribe medication, the nurses manage medication and monitor behavior, and the mental health technicians handle day-to-day activity and supervision. Each member of the treatment team meets daily to discuss patient progress and deem a patient fit or unfit for discharge. Patients also are entitled to engage in structured programming at different times throughout the day, from music therapy to art therapy to time outside or time in the gymnasium. There is no individual therapy offered beyond groups.

This format works for some patients; through my internship I’ve been able to engage with many of the people in treatment at Holly Hill and hear about their experiences and how their time at the hospital has served them. Some patients were incredibly grateful for the roof over their heads, the three meals a day, and the engaged and caring staff. Others didn’t have such a pleasant experience and spoke passionately about the facilities’ shortcomings in terms of programming, ethical treatment of patients, and handling of medication.

I was lucky enough to have a holistic and multifaceted experience at Holly Hill. Interning under the Director of Clinical Services, I spent my time doing a wide variety of tasks across all different units in the hospital. Some days I collected outstanding surveys from all units and complied them for the director or inputted all of the paper survey data into the online program. I would often be stationed in one particular unit, generally the most acute units, to provide an extra hand to the therapists with collateral work (contacting patients’ families, calling sheriffs to arrange transportation, finding available homeless shelters or care facilities for patients discharging, etc.). I sat in on and engaged with many different group therapy sessions, discussing addictive behavior, brainstorming positive coping strategies, writing songs with patients in music therapy, or playing checkers or throwing a ball outside. I helped with aspects of admissions and discharge procedures alongside therapists. Patients came to me to ask when they were discharging, request certain items or even a snack, or share information to be relayed back to their therapist. I learned from so many different clinicians who were kind enough to chat with me and share their education and career path and allow me to observe how they went about their job.

I am incredibly grateful to have had the opportunity to engage so thoroughly in so many different aspects of the hospital’s proceedings. It heavily informed my understanding of serious mental illness, especially substance use, schizophrenia, bipolar disorder, as well as active psychotic and manic episodes. I began to grasp the significant lack of resources available to people who are in need of mental health care, which inspires me to work towards making access more ubiquitous and affordable. I’ve learned that I want to gear my therapy practice towards individual and not group settings, because it is important to me to build a strong therapeutic relationship with patients and be able to address their needs individually and thoroughly. I will be able to take these lessons with me through grad school and into my practice someday to support a wide variety of people in need of mental health care.