What to Expect in the Psych Hospital
I’ve already composed a post here about the rules, what to bring, and what not to bring when staying in a psychiatric hospital/unit/ward (whatever terminology you wish to choose). This post will be elaborate more on the what the process of admission is from the ER to inpatient and the daily going-on’s of the unit.
The Process of Admission from the ER
Initial admission begins in the ER, and starts with you walking in saying that you are suicidal.
Once you disclose you are suicidal, you’ll be asked if you attempted to harm yourself. If you have, it’s critical you tell them. Overdoses, self-inflicted injuries, attempted hanging or suffocation, or any other method that’s tried all need immediate medical consult.
If you admit to having attempted you will be brought back immediately for treatment.
If you haven’t attempted, you’ll be asked to take a seat and put through the process of intake. If this is a new hospital, you may have some paperwork to sign. If you’ve been a prior patient (even for non-mental health problems), you’ll likely only be asked for your ID, insurance card (if you have it), and to sign a consent form.
You should read everything you sign, but it’s important to be aware that consenting to treatment in the ER is not consenting to admission inpatient. This is only allowing the medical and psychiatric staff in the ER to treat you, if it is determined that you are to be admitted inpatient, there will be more paperwork you sign later.
You’ll receive your hospital band, and depending on how busy the ER is, either be asked to sit in the waiting room or possibly taken back to the treatment area.
Soon enough you’ll be greeted by someone who is called your “1-to-1 sitter”. This person is there to make sure you don’t hurt yourself while you’re in the ER. They will sit next to you, take notes on your behavior, and you are more than welcome to talk to them. They’ll come with you wherever you go, though for the most part you won’t be going far.
If you need to use the bathroom at this point, ask if you need to provide a urine sample. You likely will need to provide one (tox screen, pregnancy test, etc), and doing so early means you don’t have to wait around for your bladder to fill again.
Your 1-to-1 will follow you to the bathroom and stand outside the door, you may have to keep up a conversation while doing your business as it ensures that you’re not attempting to harm yourself.
When you’re brought back to the treatment area you’ll be asked to surrender your clothes and other items (any bags or purses).
You’ll have to change into the ‘clothing’ provided by the hospital for those who are suicidal. It depends on where you are. It could be a gown made of cloth or paper, or you may be able to choose a paper shirt/pants. I would highly suggest choosing the shirt/pants option if you can.
Two things to make sure you bring and ask about keeping are your cell phone and chapstick. I was allowed to keep my cell phone until I was admitted to the inpatient unit, chapstick is a welcome relief to the typical dryness of the hospital.
Before you can go through a psychiatric evaluation, you need to be cleared medically. This is where the urine screening and blood work come into play, and also where you meet the medical doctor (or physician assistant).
Don’t be ashamed or scared of having your urine screen come back positive for any illegal drugs. So long as you’re not trying to bring illegal drugs into the hospital, you don’t have anything to worry about. This is used strictly to aid in your treatment. As a doctor once told me, “I don’t care if you come back positive for everything, I just want to make sure you get the correct treatment”.
The blood work will be looking for various things. This is to rule out any physical causes for how you’re feeling. Thyroid dysfunction, electrolyte imbalances, and so forth can actually cause mental health problems.
If there’s any suspicion of an overdose, the blood work will include looking for evidence of that. This is where, if you lied about making an attempt, you will have a lot of explaining to do.
Once you’re medically clear, you’ll now undergo the psych eval. This is where everything and anything should be discussed. Let everything out, even if that means you begin crying. The person you’re speaking with will have questions, but for most part the eval is semi-structured. Meaning, there’s required questions but there’s also time for free discussion.
In order to properly help you, you need to be honest with how you’re feeling. You’ve done a fantastic first step of going to the hospital, that’s the hardest part, now it’s time to let down your emotional walls and talk about everything that has caused you to come to the place you’re in.
The discussion or questions may become overwhelming, or triggering, or things you feel you cannot speak about. Express this. If you are unable to talk about a trauma, for example, saying “yes, I had a trauma but I can’t talk about it now”. This is acceptable. Perfectly acceptable.
After you’ve been screened, you’ll have some more waiting time. This is when your “case” is discussed and evaluated among your assigned care team.
Once a decision or recommendation is made, you’ll be informed of it. If your team has decided that you pose enough of a risk to qualify for inpatient care, you’ll be asked to voluntarily admit yourself. Do this. Involuntary commitment is something you want to avoid.
If your care team returns and says they are comfortable discharging you, make sure you voice your opinion. If you feel unsafe, tell them. If you feel that you will harm yourself upon discharge, tell them. I have never heard of someone who wants to admit themselves because they are suicidal denied that option.
If you decide to agree to admit yourself, you’ll some forms to sign. That you voluntarily are admitting yourself to the hospital for inpatient care and you are aware the reasons you are doing so.
You may have to wait again, this time for a bed to be assigned on the inpatient unit. Additionally, some hospitals wait for shift changes until they admit new patients to the psychiatric unit.
When you’re ready to be transferred from the ER to the inpatient unit you’ll have your clothing and items returned. Well, technically you’ll be transported with them, not necessarily have them in your actual possession.
Most likely you’ll be transported in a wheelchair to the unit, it can serve two purposes. The first ensuring that you won’t make a mad dash to the nearest exist, the second which may simply be hospital policy. The 1-to-1 that’s been with you hands over “care” to the person transporting you and, if they’re kind, may wish you “good luck”.
With that, you’ve been discharged from the ER and admitted to the hospital.
Arriving to the unit may be unnerving. Even in voluntary units, the doors still lock. You’ll see that everyone has to be buzzed in, or holds an ID that can unlock the doors.
Once you actually get into the unit, you’ll have, guess what, more paperwork. This is where you sign more consent to treatment forms, acknowledge that you received the list of “patient rights”, agree to abide by the “rules” of the unit, and fill out various assessments regarding your emotional state at the present moment.
You may be asked seemingly bizarre questions by the nurses such as “I’m giving you a list of three things, I want to you try to remember them when I ask you later”. These aren’t really bizarre, just another tool to measure where you cognitively are.
You’ll eventually have your stuff searched and returned to you. Anything that isn’t allowed will be stored away either in a safe (for expensive items like cell phones, money, credit cards, etc), a ‘cubby’ (for things that you are allowed observed access to like conditioner, packaged food, etc) or, if you have family/friends with you, give the items to them. Another option is having them stored until you are able to have a visitor come to pick them up.
Most units allow for patients to wear street clothes, so you’ll be able to change back into the clothing you arrived to the ER in (minus any strings, etc that you could use to harm yourself with).
If you have arrived with any self-inflicted injuries (even non-suicidal wounds), the nurses will privately ask to see them. They are not there to judge you, but need to make sure the wounds don’t become infected/are properly cared for. As someone who self-harms, I know this can cause anxiety, but honestly I’ve had the kindest responses from the nursing staff.
When you’re ready to be shown to your room after you’ve gone through the unit’s intake, you’ll receive the typical “welcome package” to the unit. Toothbrush and toothpaste, shampoo, body soap, etc. You’ll be shown to your room, given a short run down of the unit, its schedule and where things are.
The Typical On-Going’s of the Unit
For an unknown (to me) reason, many patients end up arriving to the unit later in the evening/night. If this is the case you’ll put your stuff down, get a bit situated in your room while you wait for any medications you may be prescribed to come up from pharmacy. Very typically the ER doctors/psychiatrists write an order for something to help patients sleep their first night if they are not otherwise taking medications. Trazodone is common and it will knock you out pretty well.
Continuing on from arriving at night, you’ll fall asleep and likely wake up to getting your vitals taken by the nursing staff. You’ll probably be a bit groggy but breakfast will arrive soon, and thanks to your fellow patients, you’ll be sure to know when they’ve brought it up to the unit. Because, as you’ll learn, meal times are exciting.
Breakfast will be pretty blah for you first day. It’s the standard meal that everyone gets upon arriving, and any dietary restrictions discussed the night before would slightly alter it.
At breakfast you’ll be able to fill out your menu selection for the day and the next morning. It can be complicated but other patients are very willing to help you understand it.
Typically as you eat breakfast you’ll have a sheet you fill out regarding current symptoms, you’ll have another identical one in the evening. It’s in your best interest to be honest, as you are there to get the help you deserve.
You’ll learn that the days are very structured as routine is key to aiding stability and promoting healing. I suggest you participate or even just attend the groups during the day. You likely won’t be required to go to the groups, but your lack of participation is noted.
Because most inpatient units are short-stay you’ll meet with a psychiatrist who will assess your functioning, symptoms, prescribe medications, and eventually determine when you can be discharged.
Most of the time the new patients are the first ones the psychiatrist meets with first.
If you’ve elected to isolate yourself in your room (which you shouldn’t do), the psychiatrist may come into your room to speak to you. You can’t escape the fact that some way or another, you will have to talk to the psychiatrist.
Following the daily schedule doesn’t just leave you stuck in groups all day, you’ll have free time and it allows for visiting hours. Some days are less intense, typically the weekends you’ll find yourself with more free time. Watch some TV, read, write, tidy your room, use this time beneficially, and yes sometimes it’s healthy to take naps during your free time.
A lot of your fellow patients will be kind and willing to help you out. Those who’ve been “in” for a few days, or who have had previous hospitalizations may offer a “tour” of the unit. There’s often not much to really give a tour about, but it’s a fun sort of thing to do.
Peer support is actually hugely important, and I’ve had some of the best conversations with other patients.
You’ll have some of the most honest conversations of your life in the hospital. The question of, “so what are you in for?” (or along those lines) will come up with every new patient who arrives. And people aren’t too shy about asking that.
Soon enough you’ll know the routine, you’ll make new-found friendships, learn to laugh - actually laugh - again, learn everyone’s “story” and that you’re far from alone. You’ll laugh at the most ridiculous things, you’ll laugh even harder when you realize that the nurses are noting the fact you’re laughing at something so ridiculous. You’ll laugh until you cry tears of joy. You will laugh hard and cry hard. You will begin to heal. You will begin to feel whole again. You’ll be amazed and think, “what the hell didn’t I do this earlier?” Before you know it you’ll be walking into group announcing with excitement “I’m being discharged!”
