What to Expect in the Psych Hospital
Iâve 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-onâs 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, youâll be asked if you attempted to harm yourself. If you have, itâs critical you tell them. Overdoses, self-inflicted injuries, attempted hanging or suffocation, or any other method thatâs tried all need immediate medical consult.
If you admit to having attempted you will be brought back immediately for treatment.Â
If you havenât attempted, youâll 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 youâve been a prior patient (even for non-mental health problems), youâll 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 itâs 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.
Youâll 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 youâll be greeted by someone who is called your â1-to-1 sitterâ. This person is there to make sure you donât hurt yourself while youâre in the ER. They will sit next to you, take notes on your behavior, and you are more than welcome to talk to them. Theyâll come with you wherever you go, though for the most part you wonât be going far.Â
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 donât have to wait around for your bladder to fill again.Â
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 youâre not attempting to harm yourself.Â
When youâre brought back to the treatment area youâll be asked to surrender your clothes and other items (any bags or purses).Â
Youâll have to change into the âclothingâ 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.Â
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).
Donât be ashamed or scared of having your urine screen come back positive for any illegal drugs. So long as youâre not trying to bring illegal drugs into the hospital, you donât have anything to worry about. This is used strictly to aid in your treatment. As a doctor once told me, âI donât care if you come back positive for everything, I just want to make sure you get the correct treatmentâ.
The blood work will be looking for various things. This is to rule out any physical causes for how youâre feeling. Thyroid dysfunction, electrolyte imbalances, and so forth can actually cause mental health problems.
If thereâs 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.Â
Once youâre medically clear, youâll 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 youâre speaking with will have questions, but for most part the eval is semi-structured. Meaning, thereâs required questions but thereâs also time for free discussion.
In order to properly help you, you need to be honest with how youâre feeling. Youâve done a fantastic first step of going to the hospital, thatâs the hardest part, now itâs time to let down your emotional walls and talk about everything that has caused you to come to the place youâre 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 âyes, I had a trauma but I canât talk about it nowâ. This is acceptable. Perfectly acceptable.
After youâve been screened, youâll have some more waiting time. This is when your âcaseâ is discussed and evaluated among your assigned care team.
Once a decision or recommendation is made, youâll be informed of it. If your team has decided that you pose enough of a risk to qualify for inpatient care, youâll 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.Â
If you decide to agree to admit yourself, youâll 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 youâre ready to be transferred from the ER to the inpatient unit youâll have your clothing and items returned. Well, technically youâll be transported with them, not necessarily have them in your actual possession.Â
Most likely youâll be transported in a wheelchair to the unit, it can serve two purposes. The first ensuring that you wonât make a mad dash to the nearest exist, the second which may simply be hospital policy. The 1-to-1 thatâs been with you hands over âcareâ to the person transporting you and, if theyâre kind, may wish you âgood luckâ.
With that, youâve 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. Youâll see that everyone has to be buzzed in, or holds an ID that can unlock the doors.
Once you actually get into the unit, youâll have, guess what, more paperwork. This is where you sign more consent to treatment forms, acknowledge that you received the list of âpatient rightsâ, agree to abide by the ârulesâ 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 âIâm giving you a list of three things, I want to you try to remember them when I ask you laterâ. These arenât really bizarre, just another tool to measure where you cognitively are.
Youâll eventually have your stuff searched and returned to you. Anything that isnât allowed will be stored away either in a safe (for expensive items like cell phones, money, credit cards, etc), a âcubbyâ (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 youâll 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 donât become infected/are properly cared for. As someone who self-harms, I know this can cause anxiety, but honestly Iâve had the kindest responses from the nursing staff.Â
When youâre ready to be shown to your room after youâve gone through the unitâs intake, youâll receive the typical âwelcome packageâ to the unit. Toothbrush and toothpaste, shampoo, body soap, etc. Youâll be shown to your room, given a short run down of the unit, its schedule and where things are.Â
The Typical On-Goingâs 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 youâll 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.Â
Continuing on from arriving at night, youâll fall asleep and likely wake up to getting your vitals taken by the nursing staff. Youâll probably be a bit groggy but breakfast will arrive soon, and thanks to your fellow patients, youâll be sure to know when theyâve brought it up to the unit. Because, as youâll learn, meal times are exciting.
Breakfast will be pretty blah for you first day. Itâs the standard meal that everyone gets upon arriving, and any dietary restrictions discussed the night before would slightly alter it.
At breakfast youâll 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 youâll have a sheet you fill out regarding current symptoms, youâll have another identical one in the evening. Itâs in your best interest to be honest, as you are there to get the help you deserve.
Youâll 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 wonât be required to go to the groups, but your lack of participation is noted.
Because most inpatient units are short-stay youâll meet with a psychiatrist who will assess your functioning, symptoms, prescribe medications, and eventually determine when you can be discharged.Â
Most of the time the new patients are the first ones the psychiatrist meets with first.
If youâve elected to isolate yourself in your room (which you shouldnât do), the psychiatrist may come into your room to speak to you. You canât escape the fact that some way or another, you will have to talk to the psychiatrist.
Following the daily schedule doesnât just leave you stuck in groups all day, youâll have free time and it allows for visiting hours. Some days are less intense, typically the weekends youâll find yourself with more free time. Watch some TV, read, write, tidy your room, use this time beneficially, and yes sometimes itâs healthy to take naps during your free time.
A lot of your fellow patients will be kind and willing to help you out. Those whoâve been âinâ for a few days, or who have had previous hospitalizations may offer a âtourâ of the unit. Thereâs often not much to really give a tour about, but itâs a fun sort of thing to do.
Peer support is actually hugely important, and Iâve had some of the best conversations with other patients.Â
Youâll have some of the most honest conversations of your life in the hospital. The question of, âso what are you in for?â (or along those lines) will come up with every new patient who arrives. And people arenât too shy about asking that.
Soon enough youâll know the routine, youâll make new-found friendships, learn to laugh - actually laugh - again, learn everyoneâs âstoryâ and that youâre far from alone. Youâll laugh at the most ridiculous things, youâll laugh even harder when you realize that the nurses are noting the fact youâre laughing at something so ridiculous. Youâll 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. Youâll be amazed and think, âwhat the hell didnât I do this earlier?â Before you know it youâll be walking into group announcing with excitement âIâm being discharged!â
