It's Time to Stop Strip Searching Psychiatric Patients

Please forgive me for the provocative title. Nothing about researching or writing this article was comfortable, and I imagine parts of this will be difficult for some people to read. We've been writing blog posts at Shrink Rap for seven years now, and often the comments from readers reflect their dissatisfaction with the psychiatric care they’ve received.

Recently, a reader wrote in to discuss how violated she felt about being made to undress as part of the admission procedure to a psychiatric unit. She was required to undress in front of a staff member, and called this a “strip search,” and I borrowed her term for my article title.This patient had been a victim of sexual abuse, and felt the body search was humiliating and retraumatizing.
      
I hadn’t realized that patients were searched in this way – I’ve worked exclusively in outpatient settings since residency, and no patient has ever mentioned an issue with a body search while they were on an inpatient unit. But I was not surprised, and I assumed this must be routine procedure on all psychiatric units. It is the obligation of the inpatient service to do what is necessary to keep the patients and staff safe, and we all suffer minor indignities in the name of health, safety, or even the communal shower at the gym. Initially, I assumed that some form of a “strip search” was one of those moments to be endured.
    
What did surprise me was when other readers responded with such a wide variety of experiences about the policies at different psychiatric hospitals. Some had multiple admissions and were told to undress at one facility, but not at another. Some described more sensitive searches where they were instructed to change into a gown privately and to hand their clothes to a nurse.  Others felt they were being purposely humiliated as part of a power play by the staff, and described being made to stand naked, stretch their arms, or have their clothing removed forcibly against their will.
     
Earlier this month, the Supreme Court affirmed the right of the police to conduct strip searches on people who are arrested for even the most minor of offenses.  Florence vs. Board of Chosen Freeholders was filed by a man who was erroneously arrested while driving with his family, for not paying a traffic fine. In fact, he had paid the fine years before. During the course of his six-day incarceration, he was strip searched twice, and the media reported jarring details.  I posted about this on Shrink Rap, and readers again began writing in with the indignities they suffered in psychiatric hospitals.

I started to wonder how common this is. If some hospitals do not feel it is necessary to have patients undress in front of staff to maintain safety, why do others? In Massachusetts, a patient filed a suit against a hospital after she was forcibly undressed by five male guards during a voluntary visit to the ER. In Sampson vs. Beth Israel Deaconess, the hospital settled the suit and changed its policies on blanket “strip search” requirements for all psychiatric patients.  

In Vermont, Anne Donahue wrote in the Fall 2009 edition of Counterpoint, (a newsletter for psychiatric survivors, consumers, and their families) in “Strip Searches: Going Too Far?”:

The new policy was only in effect for a few weeks. Mandatory full body searches for every person being admitted to the psychiatric unit at Rutland Regional Medical Center were discontinued. Under the new safety search policy, a patient removes all clothing behind a curtain so that the clothing can be searched. Only a specific risk of harm in an individual circumstance might lead to a full body search.

Still wondering, I posted a quick survey on Shrink Rap asking about body searches.  The responses I got were a snapshot, not a scientific study as there was no validation, no controls, and I left it to the reader to define “strip search.”  I asked readers to take the survey if they’d been hospitalized in the last 3 years.  For what it’s worth the majority of respondents – just over half – had not been strip searched.  Of those who had been, most, but not all, found the experience to be “very distressing.”   
 
One patient wrote:

I was strip searched 2 years ago. It was in a private university, top five hospital in New York City, New York state. The admission was voluntary, for depression. I was told that I was being searched because it was the policy because they needed to mark all scars and open wounds present on my body in case more appeared later – to prevent litigation. I protested I had no history of violence against myself or others and no diagnosis of personality disorder. I was told the policy was across the board. I protested that the other branch of this same hospital, where I had been a month earlier, did not strip search me. They matter of factly said that I was lying because it was a hospital wide policy.
I was directed to take off all my clothing except underwear and bra, and turn around holding out all my limbs one at a time. There were two women (I am female) present. The door was closed. I was then asked to remove my bra, replace it, and then lower my underwear front and back, then replace it. I was then told to replace my clothing while they continued searching my belongings. One nurse seemed apologetic. The other was angry that I was questioning the procedure.

I was biting back tears of shame, humiliation and flat out terror, despite never having been abused in any way. It was a gross violation of my privacy and personhood.

Another wrote:

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.

If you would like to comment on this article here, please register with CLINICAL PSYCHIATRY NEWS. If you are already registered, please log in to comment.

If you would like to see the Shrink Rap readers comments on “Tell Me About Your Psych Unit Search Stories,” please go here.  You are welcome to join in the discussion on Shrink Rap.

Dr. Miller is the co-author of Shrink Rap: Three Psychiatrists Explain Their Work, recently released by Johns Hopkins University Press.

Please forgive me for the provocative title. Nothing about researching or writing this article was comfortable, and I imagine parts of this will be difficult for some people to read. We've been writing blog posts at Shrink Rap for seven years now, and often the comments from readers reflect their dissatisfaction with the psychiatric care they’ve received.

Recently, a reader wrote in to discuss how violated she felt about being made to undress as part of the admission procedure to a psychiatric unit. She was required to undress in front of a staff member, and called this a “strip search,” and I borrowed her term for my article title.This patient had been a victim of sexual abuse, and felt the body search was humiliating and retraumatizing.
      
I hadn’t realized that patients were searched in this way – I’ve worked exclusively in outpatient settings since residency, and no patient has ever mentioned an issue with a body search while they were on an inpatient unit. But I was not surprised, and I assumed this must be routine procedure on all psychiatric units. It is the obligation of the inpatient service to do what is necessary to keep the patients and staff safe, and we all suffer minor indignities in the name of health, safety, or even the communal shower at the gym. Initially, I assumed that some form of a “strip search” was one of those moments to be endured.
    
What did surprise me was when other readers responded with such a wide variety of experiences about the policies at different psychiatric hospitals. Some had multiple admissions and were told to undress at one facility, but not at another. Some described more sensitive searches where they were instructed to change into a gown privately and to hand their clothes to a nurse.  Others felt they were being purposely humiliated as part of a power play by the staff, and described being made to stand naked, stretch their arms, or have their clothing removed forcibly against their will.
     
Earlier this month, the Supreme Court affirmed the right of the police to conduct strip searches on people who are arrested for even the most minor of offenses.  Florence vs. Board of Chosen Freeholders was filed by a man who was erroneously arrested while driving with his family, for not paying a traffic fine. In fact, he had paid the fine years before. During the course of his six-day incarceration, he was strip searched twice, and the media reported jarring details.  I posted about this on Shrink Rap, and readers again began writing in with the indignities they suffered in psychiatric hospitals.

I started to wonder how common this is. If some hospitals do not feel it is necessary to have patients undress in front of staff to maintain safety, why do others? In Massachusetts, a patient filed a suit against a hospital after she was forcibly undressed by five male guards during a voluntary visit to the ER. In Sampson vs. Beth Israel Deaconess, the hospital settled the suit and changed its policies on blanket “strip search” requirements for all psychiatric patients.  

In Vermont, Anne Donahue wrote in the Fall 2009 edition of Counterpoint, (a newsletter for psychiatric survivors, consumers, and their families) in “Strip Searches: Going Too Far?”:

The new policy was only in effect for a few weeks. Mandatory full body searches for every person being admitted to the psychiatric unit at Rutland Regional Medical Center were discontinued. Under the new safety search policy, a patient removes all clothing behind a curtain so that the clothing can be searched. Only a specific risk of harm in an individual circumstance might lead to a full body search.

Still wondering, I posted a quick survey on Shrink Rap asking about body searches.  The responses I got were a snapshot, not a scientific study as there was no validation, no controls, and I left it to the reader to define “strip search.”  I asked readers to take the survey if they’d been hospitalized in the last 3 years.  For what it’s worth the majority of respondents – just over half – had not been strip searched.  Of those who had been, most, but not all, found the experience to be “very distressing.”   
 
One patient wrote:

I was strip searched 2 years ago. It was in a private university, top five hospital in New York City, New York state. The admission was voluntary, for depression. I was told that I was being searched because it was the policy because they needed to mark all scars and open wounds present on my body in case more appeared later – to prevent litigation. I protested I had no history of violence against myself or others and no diagnosis of personality disorder. I was told the policy was across the board. I protested that the other branch of this same hospital, where I had been a month earlier, did not strip search me. They matter of factly said that I was lying because it was a hospital wide policy.
I was directed to take off all my clothing except underwear and bra, and turn around holding out all my limbs one at a time. There were two women (I am female) present. The door was closed. I was then asked to remove my bra, replace it, and then lower my underwear front and back, then replace it. I was then told to replace my clothing while they continued searching my belongings. One nurse seemed apologetic. The other was angry that I was questioning the procedure.

I was biting back tears of shame, humiliation and flat out terror, despite never having been abused in any way. It was a gross violation of my privacy and personhood.

Another wrote:

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.

If you would like to comment on this article here, please register with CLINICAL PSYCHIATRY NEWS. If you are already registered, please log in to comment.

If you would like to see the Shrink Rap readers comments on “Tell Me About Your Psych Unit Search Stories,” please go here.  You are welcome to join in the discussion on Shrink Rap.

Dr. Miller is the co-author of Shrink Rap: Three Psychiatrists Explain Their Work, recently released by Johns Hopkins University Press.

Please forgive me for the provocative title. Nothing about researching or writing this article was comfortable, and I imagine parts of this will be difficult for some people to read. We've been writing blog posts at Shrink Rap for seven years now, and often the comments from readers reflect their dissatisfaction with the psychiatric care they’ve received.

Recently, a reader wrote in to discuss how violated she felt about being made to undress as part of the admission procedure to a psychiatric unit. She was required to undress in front of a staff member, and called this a “strip search,” and I borrowed her term for my article title.This patient had been a victim of sexual abuse, and felt the body search was humiliating and retraumatizing.
      
I hadn’t realized that patients were searched in this way – I’ve worked exclusively in outpatient settings since residency, and no patient has ever mentioned an issue with a body search while they were on an inpatient unit. But I was not surprised, and I assumed this must be routine procedure on all psychiatric units. It is the obligation of the inpatient service to do what is necessary to keep the patients and staff safe, and we all suffer minor indignities in the name of health, safety, or even the communal shower at the gym. Initially, I assumed that some form of a “strip search” was one of those moments to be endured.
    
What did surprise me was when other readers responded with such a wide variety of experiences about the policies at different psychiatric hospitals. Some had multiple admissions and were told to undress at one facility, but not at another. Some described more sensitive searches where they were instructed to change into a gown privately and to hand their clothes to a nurse.  Others felt they were being purposely humiliated as part of a power play by the staff, and described being made to stand naked, stretch their arms, or have their clothing removed forcibly against their will.
     
Earlier this month, the Supreme Court affirmed the right of the police to conduct strip searches on people who are arrested for even the most minor of offenses.  Florence vs. Board of Chosen Freeholders was filed by a man who was erroneously arrested while driving with his family, for not paying a traffic fine. In fact, he had paid the fine years before. During the course of his six-day incarceration, he was strip searched twice, and the media reported jarring details.  I posted about this on Shrink Rap, and readers again began writing in with the indignities they suffered in psychiatric hospitals.

I started to wonder how common this is. If some hospitals do not feel it is necessary to have patients undress in front of staff to maintain safety, why do others? In Massachusetts, a patient filed a suit against a hospital after she was forcibly undressed by five male guards during a voluntary visit to the ER. In Sampson vs. Beth Israel Deaconess, the hospital settled the suit and changed its policies on blanket “strip search” requirements for all psychiatric patients.  

In Vermont, Anne Donahue wrote in the Fall 2009 edition of Counterpoint, (a newsletter for psychiatric survivors, consumers, and their families) in “Strip Searches: Going Too Far?”:

The new policy was only in effect for a few weeks. Mandatory full body searches for every person being admitted to the psychiatric unit at Rutland Regional Medical Center were discontinued. Under the new safety search policy, a patient removes all clothing behind a curtain so that the clothing can be searched. Only a specific risk of harm in an individual circumstance might lead to a full body search.

Still wondering, I posted a quick survey on Shrink Rap asking about body searches.  The responses I got were a snapshot, not a scientific study as there was no validation, no controls, and I left it to the reader to define “strip search.”  I asked readers to take the survey if they’d been hospitalized in the last 3 years.  For what it’s worth the majority of respondents – just over half – had not been strip searched.  Of those who had been, most, but not all, found the experience to be “very distressing.”   
 
One patient wrote:

I was strip searched 2 years ago. It was in a private university, top five hospital in New York City, New York state. The admission was voluntary, for depression. I was told that I was being searched because it was the policy because they needed to mark all scars and open wounds present on my body in case more appeared later – to prevent litigation. I protested I had no history of violence against myself or others and no diagnosis of personality disorder. I was told the policy was across the board. I protested that the other branch of this same hospital, where I had been a month earlier, did not strip search me. They matter of factly said that I was lying because it was a hospital wide policy.
I was directed to take off all my clothing except underwear and bra, and turn around holding out all my limbs one at a time. There were two women (I am female) present. The door was closed. I was then asked to remove my bra, replace it, and then lower my underwear front and back, then replace it. I was then told to replace my clothing while they continued searching my belongings. One nurse seemed apologetic. The other was angry that I was questioning the procedure.

I was biting back tears of shame, humiliation and flat out terror, despite never having been abused in any way. It was a gross violation of my privacy and personhood.

Another wrote:

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.

If you would like to comment on this article here, please register with CLINICAL PSYCHIATRY NEWS. If you are already registered, please log in to comment.

If you would like to see the Shrink Rap readers comments on “Tell Me About Your Psych Unit Search Stories,” please go here.  You are welcome to join in the discussion on Shrink Rap.

Dr. Miller is the co-author of Shrink Rap: Three Psychiatrists Explain Their Work, recently released by Johns Hopkins University Press.