Stripped for Safety: The Hidden Cost of Psychiatric Hospital Protocols

When someone enters a psychiatric hospital, the first thing they often lose isn’t their freedom — it’s their shoelaces. Or their belt. Or their pencil. Items that once seemed trivial are suddenly taken away. What remains is a standard-issue hospital gown, socks with rubber soles, and the crushing realization that the small objects of daily life; the ones that connect us to routine, creativity, and individuality … are now considered dangerous. These practices didn’t emerge overnight. They are the result of decades of evolving safety protocols in mental health care, policies designed to protect lives. But while they aim to prevent harm, they often unintentionally contribute to something more insidious: the erosion of identity and purpose.

The Erosion of Identity

Psychiatric hospital stays can already feel like an existential blur: Time loses shape, days blend together, and patients often feel more like cases than individuals. When you're stripped of your clothing, your possessions, your writing materials, you begin to feel stripped of your identity as well. You’re not “you” anymore, no longer an individual with hobbies and interest. You’re a patient, a diagnosis to be treated, a chart with a number. This disconnection can deepen feelings of despair. Rather than fostering healing, it can compound the very symptoms that brought someone to the hospital in the first place: Feelings of worthlessness, hopelessness, and being misunderstood.

Objects as Extensions of Self

While these measures may protect the body, they often harm the mind in other, less visible ways. In the name of safety, patients are stripped not just of potential tools of self-harm, but of autonomy and self-expression. Shoelaces aren’t just accessories: They’re part of daily life. Tying your shoes is a small act of independence, a signifier of routine, even purpose. Shoelaces imply tying your shoes to get up and go somewhere. Thus, removing this, removes a sense of control in one’s routine, in an environment where choice is limited. Similarly, a pencil isn’t just graphite and wood. It’s a means to process, to document, to serve as an outlet of self-expression. These seemingly small items symbolize larger gestures with an even greater emotional weight they carry.

Emily, a former patient at a psychiatric facility in New York, recalls:

“They took my journal and pen on the first day. That hit me harder than I expected. Writing was how I stayed grounded. Without it, I started feeling like a ghost of myself.”

It’s a sentiment echoed by many who’ve been hospitalized: The idea that in trying to protect them, the system unintentionally flattens them. What’s meant to be a healing space becomes sterile, emotionally barren.

A Brief History of Safety-First Psychiatry

The modern psychiatric hospital system began shifting dramatically in the mid-20th century. As “asylums” gave way to more medicalized institutions, concerns about patient rights and safety gained traction. In the 1950s and 1960s, public outcry over abuse and neglect in mental institutions led to increased regulation and oversight. However, these changes often focused more on physical safety than emotional well-being.

By the 1990s, suicide prevention became a top institutional priority. With rising awareness of self-injury and liability concerns, facilities began implementing more restrictive safety protocols. The use of items like shoelaces, belts, cords, glass, and even writing instruments became increasingly scrutinized for risk analysis. Ordinary items become objects that can be dangerous to one’s self or others, and thus are restricted.

The underlying principle became one of “universal precautions”, universally categorizing items and patients alike, and blanketing a risk. However, while logical on paper, this approach often disregards the patient’s lived experience and the sense of self associated.

Staff Walking a Tightrope

Staff in behavioral health settings often find themselves caught between clinical duty and compassion. The tension is real.

Michael, a mental health technician in Connecticut, shared:

“It’s heartbreaking when someone says, ‘I just want to draw,’ and we have to say no because of a policy. We’re trained to reduce risk, but that often means we’re also removing the very things that give someone a sense of control.”

In recent years, some facilities have been re-evaluating these protocols. Programs focused on trauma-informed care and patient-centered treatment are beginning to ask: How do we balance safety with dignity?

Some have introduced supervised comfort rooms, assessed risk for art supplies, or flexible clothing policies. While these measures don’t eliminate risk, they acknowledge the need for patients to remain connected to who they are as more than just diagnoses.

Finding a Balance and Shifting Towards Healing, Not Just Survival

No one questions the intent behind safety protocols. They have saved lives. Every policy has its origin in a tragedy someone wanted to prevent from happening again.

But healing is more than just surviving — it’s about reclaiming agency, meaning, and identity. When we strip patients of the small things that make them feel human, we risk reinforcing the very despair we’re trying to treat. This shift in mindset from preventing harm to fostering hope.

Recovery doesn’t always come through medication or quiet rooms. Sometimes, it begins with something simple — a notebook. A pair of shoes. The dignity of being trusted with your own thoughts. Because the goal of psychiatric care shouldn't just be to keep people alive — it should be to help them live.

Our Mission

While working in inpatient behavioral health care, Sarah and Laura, the founders of Psych Safe Supplies, the two observed these common themes: patients reported the materials were "child-like" and that safe products for leisure and self-care were a rarity. With their combined experience and passion for client-centered care, they joined together to create Psych Safe Supplies.

They dreamt of a world where all individuals, regardless of age, needs, diagnoses, or setting restrictions, can engage in the pursuits that give them purpose and return to their self-expression. Inspired by our patients, we aim to provide thoughtful products for meaningful engagement in behavioral health settings, without compromising safety or dignity.

References & Sources

• Deutsch, Albert. The Shame of the States. Harcourt, 1948.

• Kennedy, John F. Message to Congress on Mental Illness and Mental Retardation, February 5, 1963.

• Wyatt v. Stickney, 344 F. Supp. 373 (M.D. Ala. 1971).

• Youngberg v. Romeo, 457 U.S. 307 (1982).

• The Joint Commission. National Patient Safety Goals for Behavioral Health Care & Human Services, 2025.

• SAMHSA. Suicide Prevention Toolkit for Rural Primary Care, 2009.

• National Action Alliance for Suicide Prevention. Recommended Standard Care for People with Suicide Risk, 2014.

• Bloom, Sandra L., MD. “Creating Sanctuary: Toward the Evolution of Sane Societies.” Routledge, 2013.