The female nurse told me to take off my clothes and I started shaking and sobbing into my hands covering my face. The nurse kept saying, "oh, it’s no big deal, it's not that bad,” when it clearly was very bad for me. I shook and sobbed and took off my clothes. She said she needed me to take off my underwear, too, and I shook and sobbed and said, "no no no no no." She unlatched my bra and took it as far off as possible for a person whose hands are on her face. She pulled my underwear down to my knees. She gave me a gown, which I put on hastily, then I pulled my undergarments back in place. She cheerfully said, “see it wasn’t that bad!” and left me with a couple blankets and took my clothes and other things. I wrapped myself up in the blankets as tightly as I could, curled up as small as I could, and had a panic attack for the next hour.
I wondered about the policy at our local hospitals in the Baltimore area, and I considered contacting the chairman of a number of psychiatry departments. And then I felt my stomach turn. Could I really ask if patients are strip searched? I finally decided to ask what the policies are regarding searching new admissions. Nothing about these conversations was easy.
I received a variety of responses along the entire spectrum of options. Dr. Steven Daviss, chairman of psychiatry at Baltimore Washington Medical Center told me, “We do request patients change into gowns. Most have no problem with it, they go into the bathroom, and change. If they refuse, the metal detector wand is used.”
Dr. Robert Roca, medical director at Sheppard Pratt noted, “The nursing assessment includes a head-to-toe skin examination. As a rule nothing more invasive is done.” Their assessment includes documentation of scars or lesions, and he noted that many of their patients have been victims of abuse and subsequently have histories of self-mutilation, so they feel it important to search all patients carefully.
Judith Rohde, director of the psychiatry nursing department at Johns Hopkins Hospital, told me they have access to a metal detector wand in the ER and upon admission to the units, “We ask patients to remove their shoes and socks, and invert their pockets.” Obviously, in hospitals where all patients are not asked to undress, or to do so privately, by policy, the hospital may conduct more intrusive searches if specific patients are felt to pose a risk.
Psychiatry is practiced within the context of a culture, and here we have no clear standards, and no research that shows that one hospital is safer than another, or has better outcomes, because every psychiatric patient has been forced to undress in front of staff. Until we are certain that visual inspection increases safety on psychiatry units, such policies should be ended, and replaced by practices that are more respectful of patient privacy and dignity.
As psychiatrists, we strive to mitigate psychic distress and suffering, and these searches exacerbate distress in some patients. Callous dismissal of the patients’ discomfort embarrasses our profession and fuels the vocal anti-psychiatric movements. And most of all, any requirement to strip search all psychiatric patients leaves us as egregious perpetrators of stigma against those with mental illnesses, since other medical patients are not subject to this indignity. As one patient wrote:
Anyone who has worked in a hospital knows that violence is not limited to psychiatric patients, it’s sometimes family members or ex-lovers or just patients who are mean. Regarding the issue of contraband, all units in a hospital have patients with substance abuse issues and with that, the high likelihood of drugs/alcohol being smuggled in. Hospitals don’t take the extreme approach and strip search patients upon admission to the GI or Neurology units just because some patients who are admitted have substance abuse issues or because security was called for assistance with some other unruly patient or family member a week ago. …Sadly, the practice seems only to apply to patients being admitted to some psych units in certain hospitals. I’m relieved not all hospitals do this to psych patients, or I wouldn’t be seeing the psychiatrist I see now. I would be too afraid of him.
There may be patients who do not have a problem with being strip searched. This does not justify the practice.... It’s hard enough to be a psychiatric patient as is.
Is it time for your facility to rethink patient search policies?
—Dinah Miller, M.D.