What to Know Before a Loved One Is Hospitalized

My intention in writing this is to share the experiences that I went through with my son, starting with the first manifestation of his illness and our journey through numerous subsequent episodes. I also aim to provide commentary as a parent and psychiatrist on issues that these experiences bring up, such as how the diagnostic process works in mental health, how to work with treatment providers, and medication issues. My hope is that reading this may be helpful for people with mental health issues and also their families and friends.

Getting Hospitalized

Picking Bill up at the police station, he was sitting at a table next to two police officers. I sat with them and we talked to him.

His thoughts were “loose,” meaning that each thought was only loosely connected to the next. It was like listening to a foreign language that you know well enough to get the gist of, but the specifics escape you.

The officers were polite but clearly wanted him out of the station as quickly as possible. I was concerned about whether he would take direction from me while he was in what was obviously a psychotic state. I told him we were going home first for a few minutes, then to my office. Beyond that, I didn’t yet have a specific plan.

Driving home, Bill made statements that were unrelated to anything I had said, or to anything that was remotely connected to our conversation. I parked the car and told him to go upstairs and take a shower while I made some phone calls.

I called a psychiatrist I had known from the hospital where I worked and who was now in private practice, a good diagnostician who’s also personable and reasonable. Unfortunately, the timing was off since she was about to go on maternity leave. She referred me to two colleagues and I left messages for them.

I also thought of another psychiatrist who admitted to another area hospital. My thinking was that it might be better to have Bill at a different hospital from where I worked since it might be hard to treat him like any other patient and for the staff to make decisions without worrying about what I thought.

Source: Gerd Altman / Pixabay

Considerations in Hospitalization

In most cases, unlike in my case, there is no need to consider whether family members work at the hospital where the person will be hospitalized. Other considerations, however, are important.

For instance: What insurance plan will cover the hospitalization? This is good to know in advance. If the patient has a usual psychiatrist, does that doctor admit to this hospital—or if not, what arrangements are in place for a covering psychiatrist?

How willing is the patient to go for a hospital admission? If the patient is not willing, there are local laws that permit involuntary hospitalization under certain conditions, which must include either an imminent danger to self or others—with almost all states construing the inability to provide for one’s basic needs as a danger to self.

Other required elements are that the person is unable to make a rational decision regarding the need for treatment and that without such treatment, he or she will continue to suffer mental distress. The evidence brought forth by the petitioner must include personal knowledge of specific acts or behavior that signifies a real or present danger.

Some emergency departments have mental health professionals on-site who can perform psychiatric evaluations and admit individuals to inpatient psychiatric hospitals if they feel this is appropriate. There are also emergency departments that do not have mental health professionals available.

Physicians in these facilities will instead assess individuals to ensure that they are medically stable and will then arrange for a psychiatric evaluation by telehealth or refer the person to another facility for psychiatric evaluation. Depending on the circumstances, the person may be transported by ambulance to a psychiatric facility for evaluation or the person may be given information about where to go for psychiatric evaluation.

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Factors in Favor of Hospitalization

An important reason to seek hospitalization is if the person has developed severe illness decompensation that is life-threatening and needs to be started on a new intensive treatment, such as electroconvulsive therapy (ECT), or if they are undergoing a dangerous drug withdrawal, such as withdrawal from alcohol, which can cause delirium tremens (DTs) and has a high mortality rate.

Symptoms of DTs include tremors or shakes, the most common (and most stereotypical) of DTs symptoms, confusion, and a form of delirium specific to alcohol withdrawal. This, along with tremors, is where DTs gets its name. Agitation or anxiety is a common symptom and can often lead to combative or aggressive behavior. People with DTs may have symptoms of psychosis such as paranoia, or hallucinations—seeing, feeling, or hearing things that aren’t really there, reduced awareness of the environment around them because their senses aren’t working properly, bouts of heavy sweating, and, most dangerously, seizures, which can be deadly if they turn into status epilepticus.

Other important considerations are if the person is severely ill and the diagnosis isn’t clear, with a need for diagnostic workup (brain imaging, medical and neurological consultation), or if their behavior is so erratic that they need a locked unit while medication brings their symptoms under control.

Hospital Procedures

Patients will have their valuables put into storage to ensure that there is no theft. They will be issued hospital gowns; in some cases, street clothes are permitted. They are then shown the common room and their room, which usually has a roommate.

The ward psychiatrist will stop by to discuss the treatment plan and may start the discussion of what the appropriate follow-up care will be at discharge. Family meetings may be arranged to discuss plans for family engagement in the treatment plan.

The hospital schedule will be described in terms of times for meals, scheduled occupational therapy (OT) groups, and any other regularly scheduled activities. Staff will be introduced. Patients will be given forms to complete that describe their current emotional state and their assessment of what their needs and goals are.

A visiting schedule is posted. Typically a hall phone is available for both incoming and outgoing calls so this number is important to give to family and friends. Hospitals are geared towards resolving the acute situation (treating a psychotic disorder, for example) but not towards figuring out longer-term issues, such as figuring out how to get treatment for severe ongoing family problems.

Typically, patients will be started on medication for an acute issue such as psychosis and follow-up care will be arranged. At the point when someone is considered stable enough for discharge a conference is usually arranged with their outpatient team to discuss follow-up plans and outpatient appointments are arranged.

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Just then, Bill dashed down the stairs and out the door. I ran after him, yelling, “Stop, Bill! Stop! We don’t want to have to go back to the police.” I caught up with him in the front yard, where he had frozen in a karate stance, facing the sun. His pose was menacing, and I briefly considered whether he might be violent. I walked next to him and repeated, “Bill, I don’t want to have to go back to the police station.”

“Yes, take me to the police.”

I put my arm around him and said, “Don’t worry, everything is going to be all right.”

His posture softened slightly. I wrapped my arm around his waist to ease him toward the car, and he allowed himself to be led. “We need to go now,” I said. “Get into my car so we can go.”

In the moment, your only option is doing whatever can help talk someone into a plan to keep them safe. It’s best to do this with full transparency, but if a mild degree of deception is necessary, so be it.