Psychiatric Hospitalization Survival Guide

There may come a time during your mental health recovery journey that inpatient psychiatric hospitalization is required. Thanks to the stigma we face, common misconceptions being passed as fact and a slew of other factors many of us look at mental illnesses differently than we do medical illnesses. In fact, it’s typical that mental illness is viewed as scary or dangerous...even contagious. I could (and believe me, I will) write an entire article on this aspect of mental health advocacy, but that is for another day. I bring this up, however, because stigma, misconceptions and other issues make the difficult decision to be hospitalized for your mental health even harder. This is serious because it literally involves matters of life and death, when we require inpatient care we are experiencing a life-threatening emergency.

So, before I go on I wanted to give you a quick insight into my background so you know I’m not just talking about of me arse. Over the span of thirteen years I’ve been hospitalized in psychiatric hospitals across three states. I’ve been in therapy since I was about 5 after witnessing my father attempting to murder my mother, but unfortunately was unable to get anything out of it as my mother was also my abuser...and sitting next to me in therapy sessions. Long story short, I have a long history of intense trauma and I’m working hard daily to heal. I also happen to be crazy passionate about empowering and inspiring others to do the same.

When does one require inpatient hospitalization? Well, I like to use the model we are taught at Crisis Text Line, as I am also a crisis counselor who volunteers for them. If you have a desire and a plan to kill yourself, means to carry the plan out and intent to carry it out within the next 24-48 hours you need to go straight to an emergency department of a hospital and ask for help. I know it's terrifying and often we also experience intense rage, confusion and disorientation. Your feelings are incredibly valid and understandable and your life matters so the best thing you can do for yourself and your loved ones is to admit you need help and seek it out. It's okay to not be okay, but it's not okay to hide it and then die because of it.

So it starts in the ED (emergency department) usually. You are medically cleared there and then evaluated by a psychiatrist and/or social worker or other qualified health care professional. This evaluation is to see if you truly need to be admitted or if intensive outpatient services could suffice. Please be honest, you will not be punished for telling the truth, in fact, it will only help you more to share with your care team what you're experiencing. Don’t hold your emotions back, you are suffering and you have every right to be heard. This will also empower your care team in providing you the best possible treatment. The care team you work with will have been trained to handle situations like this and in most cases, you are in genuinely caring, compassionate and safe hands. I've only had a few bad experiences myself, most were quite helpful and even life changing.

If your care team decide you need inpatient treatment they will then ask you if you are willing to admit yourself to the psychiatric unit/ward/etc voluntarily. Please note that if you decide to back out at this point they can (and most likely will) take steps to detain you and have you admitted involuntarily. While there aren't any repercussions to being admitted because you agreed I know of several that come along with being admitted involuntarily. Again, I can't stress enough how helpful it is to admit you need help and allow yourself to have it.

Laws, protocols and procedures vary from state to state. For example, many of my hospitalizations including my first and longest-term were in the State of Florida. Florida has what's called the Baker Act...which pretty much means you can accuse someone of acting looney tunes and the cops can take them into custody to be forcibly admitted to a psychiatric facility. From my personal experiences in Florida, it is best to try to remain as calm as possible and once you get to the unit you will be admitted to, be honest with your care team about what you're going through. While I had mixed experiences in Florida, most of my care teams genuinely seemed to give a damn, my situation was and is just...complex and difficult to treat.

I've also been hospitalized many times in the State of Virginia which doesn't have the Baker Act. They do, however, have the TDO (Temporary Detainment Order). If for whatever reason it is made known to a mandatory reporter like a doctor, therapist, etc that you mean to take your life and/or someone else's and you refuse to go into the hospital, the police and court system get involved and you are detained by police who take you to an inpatient facility and you are held there until your court date. As a nursing student back in 2011 I got to sit in on several TDO court cases held at Virginia Beach Psychiatric Center. These are often very short, the judge very rarely allows the person to be discharged (they have to stay longer) and emotions can get pretty intense. From my personal experience being hospitalized in the State of Virginia it's always better to agree to go in for treatment.

Once you're admitted (and let me quickly remind you that this is based off of my experiences from hospitals in Florida, Michigan and Virginia) you will be taken up to a locked unit where you will be unable to leave unless allowed and escorted by staff, or discharged. You will be greeted by a nurse and/or psychiatric technician(s) who will take you to your room where you may or may not have a roommate.

Usually with your privacy respected to the best of their ability, the staff have you undress so they can notate any injuries or distinguishing marks and search for hidden contraband. After that you're able to re-dress. Most places give you a hospital gown or scrubs to wear until your clothing is searched and given back. Some places never let their patients wear street clothing while others do. Clothing with drawstrings, hoods or other dangerous components are not allowed on any unit I've been in. Shoelaces are taken, jewelry, etc. These items will be locked up somewhere safe and returned to you upon discharge. The staff may take your vitals (which are your blood pressure, pulse oximetry and temperature) and then they will orient you to the unit. This means you get the run-down on how the unit works, when groups are, medication times, where the day room is, all that good stuff.

Your doctor may or may not have ordered medication for you right away and more often than not you will arrive on the unit in the middle of the night, exhausted and hungry. Don't be afraid to ask for anything you need: food, water, extra blanket or pillow. Some hospitals are cool and let you bring a blanket or stuffed animal from home while others don't. Try to get some sleep so you can attend groups and eat at meal times. If you skip groups, meals and stay in your room excessively your care team will most likely choose to keep you in the hospital longer. You also will be missing out on opportunities to express the pain you've been in and experience solidarity with other patients as they convey their suffering. If you don't attend group or don't take group seriously you will miss out on opportunities to heal and grow...so long story short, go to groups.

A note about food. Some hospitals I've been to have allowed off-unit dining privileges that you have to ask your doctor for during your daily check-in. Some places that have had this, in my experience, have had some pretty delicious food while others have had nasty or limited options. Unfortunately, that's just how hospitals are by nature. If you find yourself extremely hungry ask your doctor if you may have double portions, some places allow for that. If you have any dietary restrictions or allergies make sure those are respected as well. If they aren't or you have any other issues on the unit you can ask to speak to the patient advocate.

There is usually one or several patient phones available. Every place I have been to has had a phone or several mounted to the wall with a very short cord. The phones are also usually very close to the nurse's station where the nurses do their documentation, care plans, etc. There is also normally a time limit of ten minutes so everyone can have a chance to make calls, and I want to say most places cut the phones off around 10-10:30 pm.

Next I want to talk about the Day room. This is a room with a tv, chairs and tables and normally have a few windows. Here you can often find coloring books and pages, crosswords, magazines, books, cards, board games and puzzles. Just a pro tip: don't do puzzles, they are always missing pieces and it will only frustrate you further. The day room is a pretty chill place normally to sit and color, look out the window, watch tv or chat with other patients. I like to bring my journal, art pad or Irish language flash cards and notes from school. Groups normally take place in the day room as well and most places serve meals in here. As long as it’s not loud, I normally like to spend time in there drawing or writing. Sometimes I get along with a patient or two and end up talking. If you’re feeling isolated or you are isolating try spending some time in the day room even if it’s only for a few minutes longer each time.

There will be patients that you get along with and perhaps feel a kinship with and there will be patients who piss you off no matter what facility you are admitted to. Personalities mesh and clash, that's just the nature of humanity, but do your best to keep an open mind, remember that they too are there because of suffering and strife and that you don't know their story like they do. Everyone is valid and everyone should be treated with respect. If you need space, talk to the nurses or psychiatric technicians about how that patient makes you feel and they will normally do what they can to make sure you have your space respected in terms of that patient you're having issues with.

Normally there are days and times where visitation is allowed and so far every facility except one private one, did not allow any visitors under the age of 18 in. Usually visitation is an hour, maybe two if you're really lucky and can happen daily/nightly, weekly, bi-weekly, etc. It all depends on the facility and how they run things. When you are initially admitted you're normally given a handbook on the unit that has visitation detailed in it.

Occupational and recreational therapy are so much fun and please give them a chance! It gives you a space to relax, have fun, be silly, laugh and simultaneously learn, heal and grow. These groups have always been some of my favorites. Once we even did karaoke. I sang Jefferson Airplane's "White Rabbit" and it was rad.

Some hospitals will have individual counseling sessions during your inpatient stay while others won't. You may or may not have family sessions while you are there and some require contact with a loved one who will be with you upon your discharge and asked if there are any weapons in the home.

Every day you meet with your doctor for a brief amount of time. Talk to them about your diagnoses, medications, side effects, feelings, etc. Make sure that you are given adequate information on what you're being diagnosed with and what medications you're being given. It is your right and to your benefit to know as much as you can about what's going on and how you're being treated. If something is or isn't working, convey that to the doctor so they can keep you on the track to stabilization and therefore going home.

So in closing, I want you to know that your life has value you just can't see it when you're suffering this deeply. Instead of taking your life please seek inpatient care, be honest and advocate for yourself. You deserve to heal and to feel joy. You deserve to live a life worth living. I don't know you personally, but I know the darkness similarly to you, you aren't alone and I love you. I'm proud of you.