At ComicCon 2013, while speaking about this episode, Joss Whedon mentioned that, during his time writing Astonishing X-Men, he envisioned Cyclops, whose real name is Scott Summers, making a reference to a female cousin of his who had been sent to a mental institution for believing she was a demon hunter. However, he could not find an appropriate place in the storyline to fit it in, and therefore it was never featured.
In his DVD commentary, director Rick Rosenthal says that he was a little intimidated working with Sarah Michelle Gellar at first, because she has the habit of jokingly saying to directors, "You're not the boss of me!" or "Don't tell me what to do!"
Buffy's pre-Sunnydale experience in an asylum was later told in the comic book "Slayer, Interrupted", a title reference to Girl, Interrupted (1999) which co-starred Clea DuVall who appeared in Out of Mind, Out of Sight (1997).
This marks the fifth and final appearance of Hank Summers (albeit as a hallucination).
In the very first scene, Jonathan says "I'm going Jack Torrance in here". This is a reference to the protagonist in Stephen King's novel 'The Shining (1977)'. In the film adaptation, The Shining (1980), Torrance was played by Jack Nicholson. Jack Torrance, in both the novel and film, went insane as the result of being cooped up and isolated.