Psych Hospitals


It is sometimes an appropriate response to reality to go insane
Philip K. Dick

Going to a psych hospital for the first time can feel scary and confusing, because you aren't sure what to expect and might not be comfortable asking your friends, relatives, or coworkers. It indeed can be an awkward topic to discuss, but needing (or just considering) hospitalization doesn't mean that you're a bad person or did something wrong. Abuse messes with one's head, and it's normal to seek help for the aftermath of this trauma. Most hospitals have websites where you can read about their psych units, see pictures, etc. Here's a basic idea of how it works in the USA in general:

Inpatient vs. outpatient:

Inpatient hospitalization is good for any sort of emergency or crisis, where things are out of the ordinary and less safe than usual. It's a short term intervention, not a long-term solution. You're fed, clothed, supervised, have less options to harm yourself or others, and are getting your meds, diagnosis, and treatment plan adjusted, so that you'll be on the right track and getting better help when you leave the hospital. It's like putting everything on pause and figuring out what's not working and how can it be fixed. You won't stay there till you're completely happy and healthy, only long enough for doctors to figure out what needs to be changed about your treatment, and for you to stop posing a danger to self or others. For example, you'll still be depressed, but not planning to kill yourself anymore, and having a clear and detailed plan on how to handle your depression better: prescriptions for meds, referrals for therapy, support groups, self-help ideas, etc.

Outpatient options are good for anything long-term and/or not life-threatening. If you simply need more help than one hour of therapy a week - there are outpatient programs you can use instead: more therapy, counseling, groups, etc. In some of them, you stay in hospital during the day but go home at night. On one hand, your insurance wouldn't want to pay for things you don't really need, like hospital bed, laundry, food, security guards, orderlies, janitors, etc, which come with inpatient hospitalization. On the other hand, unless your life is in danger, you would be more comfortable with outpatient treatment: you're getting the same amount of support, but sleeping in your own bed, wearing your own clothes, eating your own food, getting fresh air outside, interacting with your friends and family, having access to your phone, internet, email, etc.

Voluntary vs. involuntary:

Psychiatric hospitals are locked. Once you're in, you cannot just walk out when you feel like it; you need to ask to be discharged and wait for it to happen, even if you're there voluntarily. In the USA psych ER/hospital can hold you for up to 72 hours after you asked to be discharged (or if you never agreed to go there in the first place). This is called the Baker Act. After 72 hours they need to either let you go or commit you involuntarily. Involuntary commitment takes a court hearing, where the doctors have to prove to the judge that you aren't well enough to make decisions for yourself, and it's necessary for your safety or safety of others to keep you locked up for now. If you have to go to a hospital, it's better to go voluntarily: getting a court order to keep you against your will is much easier when you're outside, doing questionable things and refusing help, than when you're inside, watching TV and not bothering anyone. So if you refuse to go voluntarily from the start, they can commit you from the start. While if you initially go voluntarily and then ask to be discharged - it will be harder for doctors to prove that you can't make rational decisions and are a danger to self or others.

Emergency room vs. inpatient admission:

If this isn't a planned hospitalization, you first go to a psych emergency room, where you might stay for up to 72 hours and then get either discharged or sent to the psychiatric ward (often located and referred to as "upstairs"). Psych emergency room isn't the same as regular emergency room: it's locked, you wear a gown, can't go outside for a smoke, receive visitors, or use your cellphone. You might not have a bed (can nap on a stretcher instead), and it can be quite noisy, as everyone there is in an acute crisis, just got in, often drunk/high, and gets moved as soon as they calm down and/or sober up. Physical violence is a big risk, and usually results in sedation - you get a shot that makes you fall asleep for 5-10 hours. Lights are always on, staff is working around the clock (as ambulances bring more people in 24/7), but there isn't much treatment happening: the point of holding you in ER is to figure out what's going on with you, if you'll come to your senses any time soon or you need to go inpatient. They'll give you some meds, and you'll talk to doctors, nurses, and social workers a few times a day, but this is for diagnosis rather than for treatment.

Once you're past the psych ER and go inpatient, things are much calmer: you get your own bed (usually you share a room with someone else), your own doctor and social worker, and you can start making friends with other patients. Usually it's a hallway with doors to rooms where the patients sleep, a bunch of rooms for therapy (group or one on one), a nurses' station where you go to if you need anything (like a new towel or a pencil), and a common area with a TV, a public phone, and sometimes a bookshelf. There are no locks on any of the doors (including bathroom), and staff checks on you regularly, e.g. were you sleeping at night or reading till morning (so that your doctor knows to adjust your meds if necessary). You can be in your room and in the common area any time you feel like it, and in the therapy offices when you're having therapy or participating in groups/activities. Entering other people's rooms is usually a no-no even if you were invited: the staff has no way to know if your friend really wants you in their room or is just scared to say no (it's a psych hospital after all). They play it safe and encourage you to socialize in the common area instead, so that everyone has the option retreat to their room if they want/need to. Physical violence results in longer stay and possibly restraints (where you're tied to a bed by your ankles and wrists); the good way to avoid it is to not touch anyone, no matter how light or for what purpose (e.g. tugging on someone's sleeve to get their attention), and to not damage any furniture or equipment (e.g. hitting the phone when you got disconnected).

What To Pack:

Hospitals have restrictions on items you can take with you, for safety reasons. Aside from obvious things like knives and firearms, every hospital has their own list of banned items, and they can be unexpected, such as shoelaces (because one could tie them together and attempt suicide by hanging) or pens (because one could poke their eye out with one). It might seem meaningless because you aren't so unstable as to do such things - but there are other patients on the ward, and they can steal your pen and stab you in your sleep with it, you know. Look up your hospital's website and see their list; whatever is on it is something that repeatedly causes problems with their patients. Here are some ideas on what to take along:

  1. ID, health insurance card, list of medications you're taking, names and contact information of your treating professionals: therapist, psychiatrist, regular doctor, etc. It might sound like a silly reminder, but when you're going inpatient you might be too nervous to remember these things, and they need your ID to admit you.
  2. Phone numbers of people you want to be able to call. In many hospitals you won't be allowed to keep your cellphone. You'll usually have access to a public phone, but you would need to know the numbers. Just write them down somewhere, even if you don't plan to call anyone from the hospital - you never know what you might need and what kind of emergencies might happen, and you won't be allowed to go outside or go online, so phone numbers of friends or family are your only connection to the outside world.
  3. A book. Hospitals are boring: you get meds twice a day, see a doctor for 15min a day, a therapist for a half an hour (hopefully), there's food three times a day, and in good hospitals there's also group activities for maybe two-three hours a day. The rest of the time you're just sitting there doing nothing. There's usually no internet access, TV is small, placed high enough so that no one would be able to reach (and break) it, and the channel is picked by staff, so it will be Wheel of Fortune rather than movies (so as not to trigger anyone). Not all patients are talkative, and out of those who are - not all you would like to talk to either. In some hospitals you're allowed to color or journal, in many you aren't. In most you aren't allowed outside. Singing, dancing, running around - disturbs other patients, so you won't be able to do it either. This sums up to the fact that you're stuck there with absolutely nothing to do for most of the day, dying of boredom. Take a book with you.
  4. Stuffed animal. Hospital stay is a lonely and depressing time, you're out of your usual surrounding, and have no personal belongings with you. Helps to have a piece of your outside life with you, just for comfort. Especially helps to hug one at night.
  5. Personal hygiene items, if your hospital allows them. They'll usually give you a soapbar, if you don't have any, but you'd feel a lot more human if you have your toothbrush, shampoo, and a hair comb.
  6. Journal. Psych hospitals are a great opportunity to think about things, and a pen and paper help with thinking. Just check the restrictions - usually it's no spiral-bound notebooks and no metal pens, could be only pencils, could be only markers, etc.
  7. Clothing, if your hospital allows it. Don't pack too much, keep safety in mind, and go for comfortable and casual clothing rather than good looks: t-shirts, hoodie, yoga pants, tennis shoes (no laces, unless allowed), etc. Remember socks, they are a great comfort, even though usually you aren't allowed to walk around in them, without shoes. If you have long hair, don't forget something to tie it with. If your hospital doesn't allow clothing, here's a bizarre tip: put on two pairs of underwear/bra when you go there. They don't provide underwear, and without it you won't feel too good, especially if you're female and on your period. Two pairs means you'll be able to wash it in shower and rotate.