“Your present circumstances don’t determine where you can go; they merely determine where you start.” — Nido Qubein
The term “psychiatric hospital” conjures up images of that age old insane asylum, a long ago place where people were locked away in damp, dirty cells and forgotten by society. Each of these asylums was overcrowded with thousands of patients, many chained to the walls, all bereft of treatment and kindness.
Much has changed since the insane asylums of the 19th century. The American Disability Act, patient rights, HIPAA, the rise of psychotherapy & medications, and a focus on keeping people in the community (instead of in hospitals) has changed the mental health landscape. Today’s psychiatric hospitals are far from perfect, but they aren’t yesterday’s asylums.
But what’s a mental hospital like? How does one end up there, and what happens once you’ve been admitted? Hopefully this article answers these questions and gives you a sense of what it’s like to be admitted to a psychiatric (“psych”) hospital.
Why do people get hospitalized in psych hospitals?
We all need help sometimes. Occasionally that need is a desperate one, based on profound sadness or voices that bite at the mind; when this need leads to thoughts of suicide or hurting others, or behaviors so bizarre they get the person into trouble, it’s time to call 911 or go to an emergency room. These are triggers for hospitalization.
Some patients are committed. This means they’re hospitalized against their will. Commitment usually happens when a person is a danger to themselves or others but refuses hospitalization. You can also be committed if you’re too sick to consent to admission.
The need for involuntary admission is determined by a psychiatrist. However, you can’t be held long-term without a judge’s order, and you have the right to contact your own attorney at any time. Generally, the commitment papers are dropped within the week. Having an involuntary hospitalization doesn’t go on your “record.” It isn’t a crime to get mental health treatment.
“Healing takes time, and asking for help is a courageous step.” — Mariska Hargitay
How do you get admitted?
Most individuals are admitted through the emergency room (ER).
Usually it’s a crisis situation that triggers a trip to the ER. After registering with the front desk, you’re evaluated by the emergency room staff, who clear you medically before referring you to psychiatry.
Your first stop is with a social worker. They interview you, collect background information, talk to people who know you, and try to pull together the “whole” picture.
Once that first assessment is complete, a psychiatrist is called. They review the social worker’s evaluation and related documents, conduct a psychiatric evaluation, and determine whether admission is indicated. The question is always about safety.
“We are all looking for places to put our pain.” — Healthyplace.com
What happens when you’re admitted?
That walk to the unit is a nerve-wracking one, especially if it’s your first time. You’re depressed or overcome with difficult thoughts and voices, and a hospital might be the last place you want to be. But you know you’re getting help, and you find solace in that.
The unit is locked. Once inside, a nurse meets with you, and you’re asked to share your story a third time. Usually the nurse is a friendly soul, compassionate and curious, and people feel comforted by his or her presence.
The nurse asks that you give up your shoe laces, belt, and anything that could be used to hurt yourself or others. Clothes with strings aren’t allowed. Your cell phone, wallet, money, jewelry, and expensive belongings are locked away for safe keeping; you get them back upon discharge. Sometimes you’ll be asked to change into hospital garb; other hospitals let you wear your own clothes.
Next, you’re shown to your room where you can put your belongings. The bed is single-sized and covered neatly with hospital sheets and blankets, and it’s bolted firmly to the floor.
Looking around, you’ll notice everything is tied down or reinforced. The windows are covered with rigid netting. There are no big, bulky pictures on the walls. There’s no TV or phone either, not in your room. This is about safety. No one can hurt themselves or others if their world is safe.
After you’ve put your stuff down, the nurse introduces you to the other patients. Some will be withdrawn or talk to themselves. Others will be unusually excitable. But this is no One Flew Over the Cuckoo’s Nest. You’ll look in their eyes and see real human beings, each with a dream-filled story about adversity and survival. Most have spouses, children, jobs, and hobbies. If you were to see them in the street, you probably wouldn’t know they were sick.
“The most beautiful people we have known are those who have known defeat, known suffering, known struggle, known loss, and found their way out of the depths.” — Elizabeth Kubler-Ross
That first night is the hardest. The hospital staff checks on you every fifteen minutes all night long (or more often), and it can be difficult to sleep. You miss your family, house, life, and bed. It’s possible you’ll want to leave. But in the end you know this is where treatment happens the fastest, and you need to get better.
What’s the unit itself like?
Psychiatric units are made up of one or two hallways. There are usually 10-20 beds per ward, though some wards are larger. Most people share a room.
As you wander around the unit, you’ll first find the “dayroom,” a large area filled with tables and chairs that often doubles as a cafeteria. Most dayrooms have a large TV, some board games and puzzles, and maybe a few pictures on the walls. This is where patients hang out during the day. Activities and classes are frequently held here.
Just down the hallway you’ll find the medication room, where the med nurse stands behind a window and passes out tablets to the patients.
The nursing station isn’t too far off. Staff members go here to discuss patient care, complete paperwork, make phone calls, and coordinate discharge planning. If the hospital doesn’t use electronic records, the charts are kept here too.
Nearby there’s usually a treatment team room, a moderate-sized room with a large table and bunch of chairs, where the psychiatrist, nurse, social worker, and other members of the team meet every day to review patient care.
What’s a typical day like?
The day starts early in the morning with breakfast, an assortment of food off a menu you organize yourself. From there it’s a predictable routine, including leisure classes like artwork and music (these are important for the soul), as well as meditation groups, self-soothing classes, coping skill reviews, symptom management, exercise groups, education about illness, group therapy, and in special cases alcoholics anonymous. Some units offer cognitive therapy and dialectical behavioral therapy. Classes and groups are run by occupational therapy as well as social work and nursing staff. Sometimes there’s downtime, where you can chat with staff and patients, play cards, do a puzzle, or listen to music.
“I can’t change the direction of the wind, but I can adjust my sails to always reach my destination.” — Jimmy Dean
Throughout the day, you’ll meet with different members of the treatment team. That includes your psychiatrist, social worker, and nurse. See below for more information about the different players on the unit.
Sometimes you’ll have visitors, typically in the late afternoons, depending on the hospital’s visiting hours. Having guests is a godsend, a momentous event that everyone looks forward to, so patients are encouraged to let others know about their hospitalization (at least people they trust) to avoid being cut off from the outside world. You can also call your loved ones during phone hours.
How long does the stay last?
Patients stay in the hospital until they’re safe to leave. This isn’t usually long, ranging from a few days to a week or two. The average stay is 3-7 days.
There are a few long-term hospitals for people who are persistently suicidal or violent because of their mental illness; in this setting, people are stabilized after a few months and discharged, although 20+ year hospitalizations aren’t unheard of for extremely ill individuals. Long-term hospitals are uncommon these days. They are usually state-run and linked to forensic patients
Who are the treatment team?
Mental illness is very complicated, especially when it comes to crisis, and it’s hard for one provider to see and encompass every aspect of care. There are too many questions:
- How are we going to keep this person safe?
- What are the person’s needs right now, here in the hospital? What skills can they learn to help raise resilience? What about meditation, mindfulness, and creativity?
- What medications can help? Are they having side effects?
- Are they dealing with drug or alcohol withdrawal?
- What physical health problems do they have, and how does that impact their mental health?
- Do they need psychological testing to help clarify diagnosis or treatment?
- What are the problems in the person’s life? What can we do to change those problems? What can be done to improve services and stability in their external world?
Your team is called the “treatment team.” This includes a psychiatrist, social worker, nurse, nursing assistants, and sometimes an occupational therapist, chaplain, and students. The group works together to cover every aspect of your care: your medications, symptom management, family meetings, financial and housing concerns, teaching you to help yourself, plus follow-up care.
Your psychiatrist handles medication management and heads the treatment team. They typically meet with you once daily.
The social worker focuses on discharge planning. This means they’re responsible for organizing a safe place to go after you leave. They also coordinate contact with your family and make sure you have good professional support once you’re out of the hospital.
Nursing care is centered around keeping you comfortable and safe, making sure you’re doing okay with your medications, and coordinating the nursing assistants (CNA’s or “psych techs”) who work with you.
The CNA’s are perhaps the most important part of the team, as they’re the ones you’ll spend the most time with during your stay. Their role is to maintain safety, but often they run groups, monitor self-care like showers and meals, and help people deal with crises.
Keep in mind that most of the members of your treatment team studied mental health and specialized in their fields because they want to help others. They’re usually underpaid and unappreciated by their bosses, which means they’re mainly coming to work for one reason only: they care about their patients.
“What we achieve inwardly will change outer reality.” — Plutarch
What happens if I want to leave the hospital early?
Leaving the hospital against the advice of your doctor is called an “against medical advice” discharge, or “AMA.”
In most hospitals, you have to sign a paper requesting discharge. From there, the team has 1-3 days (depending on the state) to arrange your departure. If you’re not a danger to yourself or others, the psychiatrist will discharge you AMA.
AMA discharge isn’t ideal. It’s difficult for the social worker to set up a good discharge plan on such short notice, so AMA usually means leaving without follow-up appointments, prescriptions, definitive discharge location, and adequate support.
If the doctor feels you’re unsafe to leave, they may commit you to maintain safety.
Whether your psychiatrist has recommended you consider hospitalization or you have a daughter or father who just got admitted, I hope this article has answered some of your questions. Scary until you understand them, psychiatric hospitals are meant to be places of healing, where providers with good intentions do their best to do right by their patients, and where tens of thousands of people get better every year.
“And if today all you did was hold yourself together, I’m proud of you.” — healthyplace.com
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