What to Expect During Short-Term Stay on a Psychiatric Ward

Gone are the days of dark, dank, cobwebby asylums, with lobotomies and straight jackets a dime a dozen. Like every thing else that goes with mental health issues, there is quite a stigma for people being admitted to a mental health unit. Though people know better, the asylums are still way back in the recesses of their minds.

This hub will focus here on voluntary short-term stays. I won't discuss state mental hospitals as I am not knowledgeable about those. Spending time on a mental health unit does not have to be a bad experience; in fact, it can be a very positive experience. It can give you a great start in your journey to wellness. It's a place to get stable, rest, be cared for, and learn about what's happening in your life. You will find many good listeners, patients as well as staff. Most importantly you will find hope.

For most hospitals, the standard protocol if someone is in a mental health crisis is to go through the emergency room. A nurse will find out what you need to be seen for, your vitals will be taken, followed by a brief exam by a medical doctor. In many hospitals, there is usually a special room or two reserved for mental health patients. It's private and quieter.

Next, a social worker or mental health professional will come and evaluate you. They are usually very kind, and gentle, and understand how stressful your crisis is and recognize the fear you may be experiencing. The mental health professional will ask lots of questions about what your crisis, such as what led up to it, if you feel like harming yourself or someone else (they want to make sure you're safe), your diagnosis, medication, mental health history.

This evaluation is very important to determine what your treatment needs are, such as whether you need in-patient care. Before you can be admitted they need to get insurance approval, and find out bed availability.

Until all that is taken care of, you will have to wait, and a good E. R. will make sure you are safe and your immediate needs taken care of. Going to E.R. alone in a mental health crisis is not wise. In a heightened emotional state or severe depression, it may not the safest time to drive, and having someone who cares about you to be by your side and support you will make all the difference. No one wants to be alone at such times.

ADDENDUM: As a commenter just reminded me, there are times when you go to ER and you will have to wait hours just like everyone else. If there is no room, you may have to wait in the hall on a gurney. This is the worst case scenario, and is totally dependent on which hospital you go to, their policies, ER population at the given time, room availability, and the severity and riskiness of your condition. As we all know, ER's can be crazy, frenzied, and very, very, busy. As I state a couple of times in this article, there are always exceptions. That is life. But what I've written here has been most of my experiences.

If all the ducks are in a row for you to be admitted, there is a rather uncomfortable process to go through with security. If you've never been through this process before, you may be either offended or embarrassed. But it is necessary. What happens is that security comes and does a wand scan to make sure you have no harmful items on your person. You will be asked to remove your shoes, socks and jacket (no strip searches). You may have something you don't even know that could be harmful. "Now," you may say, "I am not suicidal or homicidal, so why do I have to go through this?" Even though they may believe you, there are no guarantees in their eyes and your condition could worsen unpredictably. In addition, you need to be safe from others who may get a hold of those items to hurt you, themselves or someone else. Staffers have seen everything and it is their responsibility to keep everyone safe.

Your belongings will be searched, and again, anything they feel could be used to harm yourself or others is removed. Valuables will be locked up and documented with your signature. This may be done once you get onto the unit; it depends on the hospital's protocol.

When you arrive on the unit you will usually stop at the nurses station where a nurse will take your basic information, have you sign paperwork, and ask a lot of questions. Most nurses are warm and compassionate (of course we know there are always exceptions) and understand how uneasy it is for you to be there. They try to keep this time as short as possible so you can get started on resting.

Probably the next thing that will happen is that another staffer will talk with you one on one about the issues that brought you there (briefly). They will tell you what you can expect during your stay there, such as rules of the unit, where things are, what the program is, the schedule, and how and when to get help when you need it. This is a time where they try to show compassion. They are usually willing to let you talk a bit (if they are not short-staffed) and ask questions.

Most hospitals will keep cell phones somewhere on the unit in a safe place and you may use it upon request, if their rules allow it. Any item you bring a cord, wire, or something sharp like a razor or scissors, it will be held at the nurses station or safe place and you may use them with supervision. On some stricter units they will keep shoelaces. Your belongings will be searched either in your presence or when you've gone to your room. This may be unpleasant to you. These searches and security procedures are an annoyance. But everything should go uphill from then on.

Before you head off to your room, you will be given a tour of the unit and shown where things are.

Finally you will get your chance to rest. Someone will show you to your room and encourage you to get some sleep. You may have a roommate, which can be uncomfortable the first night. If they want to chat and you're not up to it don't feel bad by saying you would like to get some sleep and you will see them in the morning. You will probably be given your meds as well and then you can rest. Sleep, in some cases, may come quickly. Being in crisis and jumping through all the hoops to get admitted can wipe you out. If the unfortunate happens and you are too full of anxiety to sleep, you may ask the nurse for something to help you sleep. There are no guarantees, as each hospital has their own protocol. Some may not give out sleep meds until you have seen the unit doctor the next day. But ask anyway. You may well get the meds.

Most of the time, on the first day, patients are allowed to sleep as long as needed and usually will not be expected to join activities unless they want to. Mental health units will have a check-in group first thing in the morning, or right after breakfast and meds. Usually you will be asked how you are feeling and be encouraged to make a goal for the day. A goal can be brushing your teeth, putting on clothes, or discuss some concerns with your doctor. It's a good way to start the day and may help keep you from being overwhelmed.

Patients must be seen by a psychiatrist every day. He or she will ask how you are feeling, what you have been experiencing leading up to your hospitalization, what meds you are on etc. The most important thing is that they listen, allow you to ask questions, and answer your questions thoroughly. Don't be afraid to ask questions. "Why are you putting me on this medication?" "What is this medication for?" "How will this medication effect me?" "What is wrong with me?" "What does it mean when I feel this way or that way?" There are no stupid questions.

Let your doctor and nurses know when might be having side effects. If anything out of the ordinary is bothering you, let them know, it could be important to your care plan or medication management.

Strangely, some psychiatrists are not really people persons, which is rather an oddity considering their profession. Don't let a doctor be dismissive, or act like you don't know what you are talking about. There can be clashes, so if you are really uncomfortable, ask for another doctor. Sometimes they will grant your wishes.

There is no laying around in bed all day watching TV. Rarely will you find a psychiatric hospital or mental health unit where they allow TV's or phones in the rooms. The reason is that patients would be inclined to isolate in their room all day and not participate in the program which is designed to get you back up and running. Some units have TV rooms with certain hours. There is always a patient phone to use, usually in a common room. Often there is a movie night.

Daytime is filled with classes and groups of various kinds. Some classes are educational, some will give you tools to manage and/or explain your symptoms. Some are recreational in nature, but with a theme that will play a part in your recovery. These classes are not offered to keep you busy for the sake of busyness. They are there to help you understand what you are dealing with and how you can take care of yourself and manage your symptoms.

Here are a few classes or groups you may find on a psychiatric unit:

• Grief and loss
• What is depression, or some other disorder?
• Ways to manage anxiety
• Relaxation exercises
• Medication education
• Coping skills
• Self-care

There are many more. And they can be very, very helpful

Most of the time you will have to stay on the unit for 24 hours before you can go off the unit to smoke, or go to the cafeteria etc. The staff must be assured that you are safe from self-harm. The doctor has to approve you to leave the unit. Some hospitals let you go off-ward independently with no supervision, but only in restricted places. Others will be supervised.

Even on voluntary units, the main doors are locked. This bothers some people because they reason if they are there voluntarily, they should not be locked in. Don't take offense. There are certain reasons for this. It is not about holding you against your will, but to protect everyone.

One reason is that if the doors are unlocked and someone decides he wants to leave and just leaves without notifying anyone, there will be a panic by staff and security because they do not know your status or safety. You could be on medication that makes you unsteady on your feet or fuzzy headed. Taking off on your own would not be safe. Also, if someone on the unit has been suicidal and they leave unnoticed, they could be held liable if the patient harms themselves. In addition, someone might enter who is not safe

If you are determined to leave without their okay, it's perfectly lawful to do so. The protocol is to have you sign papers saying you are leaving against medical advise, or perhaps your doctor approved it even though you are not well enough. They may request a ride for you. The bottom line is, if you are on a voluntary status, they cannot legally keep you there. The doors are locked for safety, but being released is always possible.

Most of the time, new patients do not feel like interacting with others, especially if the others have been there awhile and have already formed relationships with each other. It's like being the new kid in school. Surprisingly, you will notice chatter and laughing a lot on a psychiatric unit. If you are new, you may feel put off by this. Understand that as each day goes by, people start to feel more rested, safer, stable, and positive. They have had time to bond with people. You will find a lot of people will reach out to you. But if you feel the need to give it more time before engaging people, that's perfectly okay, as long as you don't isolate day after day.

Friendships like this can contribute greatly to your healing and progress. If you isolate, you will not progress.

What to do with difficult people

Difficult people are everywhere in life. The mental health unit is no exception. People are emotionally fragile when they come into the hospital. They are not themselves. The nature of some illnesses can cause behavior problems, severe anxiety, or they may not be progressing as quickly as others. Just understanding that is half the battle in dealing with difficult people. If they cross boundaries, tell the staff immediately, even if it seems minor. Usually physical touching of any kind is prohibited. Some people are not comfortable with touch and it could trigger a negative emotional reaction. If someone is angry or threatening, seek the help of staff. Psychiatric hospitals have zero tolerance for threatening or hostile behavior. The safety of all is of primary concern to staff. Policies are usually well enforced. Depending on what kind of unit you are on, some patients may be dealing with more serious mental illnesses and may behave strangely, like talking to themselves. Please understand this is part of their illness. They are not weird, they are ill. Be kind and friendly.

Most hospitals are required to make social workers available. The social worker provides many services to help patients. Here are some other things they can help you with:

• Finding and setting up appointments with out-patient practitioners
• Assistance in filing for financial help for medical bills and income needs, such as state assistance and medicaid.
• Find resources for housing and/or shelter needs
• A wide variety of other community resources
• Many times social workers are trained in mental health issues and may be part of your care team.

If you have not seen or been made aware of a staff social worker, speak to your doctor or the charge nurse and request one. Hospitals must make them available.

When you first arrive on the mental health unit you will have the privacy policy explained to you. All your information is private. You have the choice to have visitors or not. If there are certain people you do not wish to see or hear from, the staff will ask you to write them down and they will make a note of it. If you do not wish to have outside friends, family, employers, or anyone else know you're there, staff will not make your presence known. They will not verify in any way that you are a patient there.

Having visitors can be overstimulating, make you self-conscious, or stress you in any number of ways. On the other hand, having visitors who you feel safe with and comforted by can be a great boost to your day and remind you that there are people in your life who care about you and are rooting for you.

There are usually leisure activities available. It sounds childish, but many patients find coloring and simple art projects soothing and a great way to socialize. Units are usually well stocked in art supplies.

Again, most units will have a TV available. A good mental health unit will give some rules about appropriate programming. Some shows can be triggers to others, such as violence or even actors arguing. Certainly the news can be very distressing. Sometimes issues arise with people who monopolize the TV or viewing choices. Let the staff know. They are there for those kinds of things.

Almost all hospitals have movie nights, with popcorn and everything. Again, they take great care in what movies they make available. Not all movies are healthy for all patients.

Some units may have an exercise bike or treadmill. Or, they might allow you to go to another part of the hospital to use a gym. Many times outdoor walks are organized so patients can get exercise, fresh air, and a change of scenery. Sometimes an outside person will come in to lead an exercise class or relaxation group. These classes are not usually mandatory, but it can very beneficial to patients.

Puzzles, magazines, books, and the like are usually readily available. If you want some peace and quiet, it's nice to be able to go to your room and read.

Journaling is a therapeutic and relaxing activity as well. Ask for pen and paper and journal away. You can share it with a staff person if you want. Or it can for your eyes only.

Talking to staff

There should be staffers readily available at all times if you need to talk to someone. There are times when units are not well staffed and you will have to wait. Some psychiatric units have a policy that each patient will have a contact person for each shift to talk to. Sometimes they will just automatically check in with you, and other times they will come upon your request.

Watch the transformation

One thing that is good to observe is the transformation of the other patients. When people first arrive they are very depressed and withdrawn and look like they will never smile again. They are quiet during meals and groups. Within a few days, they are chatting with other patients and growing in energy and health. Having said this, it is to be expected that you and others will have bad days or moments. Don't let it discourage you. Talk with someone about the changes you have made since you have been there. They may have some very encouraging observations and comments about your transformation and/or progress.

There are some people who come into the hospital and fight tooth and nail to be allowed to do things there own way - like sleep all the time, skip classes and groups, isolate, complain about activities, rules, policies and staff. These people don't progress and they can actually cause stress to other patients and staff. You are there to get stabilized so that you can get started on your journey to wellness. If you don't participate and act difficult, you will have spent your money for nothing and wasted your time.

Whatever we need to recover from in life, we need to take part of our own recovery. Use the tools you have been given. If all you can do is take baby steps, that's okay. The important thing is that you are moving forward. Keep in mind that if staff is encouraging you to do something that you don't think is useful, or don't feel like doing, they do this because they have seen by experience that it helps. Try to trust them.

Discharge

When the doctor has decided to discharge you there will be more paperwork. The most important will be your safety plan and your treatment plan. If you felt like you wanted to hurt yourself when you first arrived on the unit, staff will help you set up a safety plan for when you get home. You will write down things you will do when you are feeling in danger of hurting yourself. A staff member will go over it with you.

The treatment plan is similar in that you write down what practioners you will see when you get out, their phone numbers, addresses, and appointment times. You will also write down support people, medication regimens, and plans to utilize resources you may have gotten from the social worker. Your belongings will all be returned for you and you will sign off to verify you received everything you came in with. Be sure and thank the staff. They really care about you and worked hard to help you.

Your visit to an in-patient, short term psychiatric unit can be a blessing in disguise. If you give it your full cooperation, you will have made enough progress and stability to leave and move on in your recovery. You should leave with tools, resources, and hope.

© Lori Colbo 2011