Today I was thinking about some of the things I wish I had known before I sought emergency mental health care. It is one thing to tell someone to go to the ER, but it is another thing to educate people on what to expect – so they will be less hesitant to seek help when they need it.
I will write later about other less acute care and how that can be accessed. This article is only about emergency hospitalizations.
Another reason for this article: until I was hospitalized for the first time, I knew absolutely nothing. I viewed mental health care through the eyes of fiction and media. For those who are just curious – I encourage it. Mental health care does not need to be a mystery.
I thought I would break it down, simply, as a general idea of what a hospital visit and stay might look like. Keep in mind that this is very general – and I am not you. I am me and my experiences, and reasons for going to the hospital, are unique to me. I am not giving psychiatric advice. If you are having a crisis please call 911 or the National Suicide Prevention Hotline.
With that said –
The ER:
I have both walked into the ER, and have been taken there via ambulance. Sometimes, when I have walked in, there is somewhat of a wait.
When I first get there, I usually go through triage, where I tell a nurse or admitting doctor why I am there and they direct me to the proper part of the hospital. In my experience, when I have told someone I am there for a psychiatric emergency they take me to the psychiatric ER, which is usually locked. This may seem scary, but in my case, it has just prevented me from walking out. Sometimes that has been essential.
I have sometimes waited in the ER for hours, and sometimes I have been admitted and have talked to a doctor right away. One time I was not admitted, psychiatrists are trained to assess people and determine if an inpatient stay is necessary. Other times, I have tried to talk my way out of the ER after I have already entered. Psychiatrists can see through this too, and it has never worked.
Most times a nurse takes my blood, a urine sample and traditional vital signs like weight and blood pressure. They also usually take my medication history, which can be tough to remember so I write it down somewhere. There have been times when I have not been able to do that, it is okay too. They usually contact my psychiatrist for that information.
If necessary I get medical attention for anything that my condition necessitates.
After a while, a doctor usually comes in and talks to me about why I am there. This is typically short, so I sometimes worry that they don’t know enough about me to admit me. Usually, they have talked to my psychiatrist too, and have heard their side. Other times, family gets involved and gives a history, which has not ever been my case.
In the ER they take my clothing, jewelry, any other items that could be used to hurt myself or someone else. They take shoes and give me hospital socks, and a hospital gown. I will get clothes back if they fit the restrictions, and people can bring me clothes. I can’t take my phone so I write down some numbers quickly on a paper. My psychiatrist, my dad’s partner, my brother.
Most hospital inpatient units will take away leggings, flip flops, scarves, shoes with laces, and pants with drawstrings. When I have walked into an ER, sometimes I bring a few things that I know will be acceptable. I have been taken by ambulance as well and in those cases, I was not prepared in that way.
The last time I was admitted, last year, I had no acceptable pants or shoes and was given some. In one case, I was given scrubs to wear.
Just Admitted:
There have been times when I fall asleep in the psychiatric ER because it has taken them so long to take me up to the inpatient unit. Most times they have taken me up in the middle of the night. It is very disorienting, but don’t worry. I usually just go right to bed, if I can. The first day or so I stay in bed and depending on where I am – meet with a doctor. I’ve been to places where I’ve seen a doctor every day, and some where I barely do. Nurses in the units are trained in this specific area, so I feel comfortable talking to them about my symptoms. I know that the doctors will hear about everything that happens in the unit anyway.
Single rooms are not typical, and it can be unnerving to share a room. Roommate experiences can be varied, but they have never affected my recovery. In some cases, a roommate becomes someone who I know a little bit better than everyone else. Activities and meals are better when I get to know my fellow patients. I have had experiences in which I just do my own thing and my roommate does too.
Food:
The first time in the cafeteria is usually quite intimidating, no matter how many times I have been hospitalized and no matter where I am. Usually, I am nudged out of bed by staff to attend an 8:00 ish AM breakfast on my first day. The food tends to be bad – powdered eggs etc. Only two places I have been in have served caffeinated coffee. It’s hard enough having a crisis, is it also necessary to be in caffeine withdrawal? The food gets more palatable the longer I stay – and sometimes a friend will bring something in. That tends to be okay during visiting hours.
Groups:
I have been in places with many groups from process groups to art therapy. Other places, however, have had very few groups. If there are groups, they can be very helpful. Yet, I, when I first arrive at the hospital am often not in the place where I can attend all groups. Most places expect me to attend groups. Attendance at group might indicate my ability to discharge. Usually, as I gain energy back, or am stabilized I go to more groups. Some of the experiences I have had in groups have been formative and invaluable. Other times I just sit there and stare at a wall. I have been so exhausted at times that I just cannot pry myself out of bed. I give myself leeway in that area due to the fact that I am in a locked unit because I am seeking help and need to take time to heal.
Patient life:
The times that I have gotten the most out of an inpatient stay were the times when I was in a place to talk to peers and learn about their challenges. They may not turn into lifelong friendships, but at least they make me feel less alone. Isolating usually prolongs my stay and my stabilization process. Some places have outdoor areas that I have been able to access.
Doctors:
Sometimes they meet with me every day for a scheduled appointment. I like that the best. On the other hand visits with a doctor can be frustratingly short and sporadic. The doctor is the only one who can sign my discharge papers so it is important for them to be aware of my condition and ability to return to my life.
Nurses and Psychiatric Technicians:
They are around every second of the day in most places I have been to over the years. I try and talk to them whenever I am feeling insecure about my recovery and stay. I have had good and bad experiences with nurses. Do not worry – it is okay not to feel a connection with every staff member on the unit. Inpatient units in my experience have been places where I’ve stabilized and released rather quickly. Psychiatric technicians can be around to help as well. Sometimes they take my vital signs or listen to me having a breakdown. Their job seems very overwhelming and underappreciated.
Discharge Planning:
It has been important for me to come up with some sort of after hospital plan. I have gone to outpatient programs and residential treatment directly after my inpatient stay. I set up an appointment with my psychiatrist and therapist immediately. This is not the only path, but it is the one I have taken. Community outpatient programs aim to help people recover and stay outside of the hospital whenever possible. Having a plan is usually a prerequisite to discharge. When I haven’t known who to see or what outpatient program I to go to, a social worker in the hospital will help me pick one. I like to keep busy, even if it is just an extension of my treatment. I badger the staff at times to talk to the doctor about letting me go early, to no avail. I often feel like I need less time to stabilize than I actually do. I feel fixed when I’m still being mended. When discharge is imminent – the doctor has to sign my discharge papers before I leave the building. This can take an excruciating amount of time.
Afterwards:
No matter how long I stay, I always feel a bit overwhelmed and disoriented leaving a locked unit. I relish having that freedom, but miss the support and constant socialization, that I take advantage of once I am stabilized. Many patients and staff have made an impact in my life. In the hospital, I have been given new medicines, new doses, and at times a new diagnosis. This can be a lot to process. I reach out to friends, or family. I see my psychiatrist three days a week. An inpatient stay has never healed me completely, nothing ever will. Yet, having the option to ask for help in the event of a severe crisis has saved my life several times. It has grounded me back to reality, away from the uncertainty in my mind. There are times when I have been hesitant to seek help, especially when I did not know what to expect.
This article expresses my experience in locked inpatient units. It is meant to be informative but not directive. Do not ask me for advice as I am not qualified enough to give it.
Do any of you have something to add? Something that you think I should change or that is not accurate? Let me know!