How safe is my sister in Bellevue Hospital's psych ward (in NYC)?

September 25, 2008 8:36 PM

My teenage sister has just been admitted to Bellevue Hospital's psychiatric ward (in New York City); should my parents let her stay put, or have her transferred to another hospital? Is there anything they should be aware of?

My sister has been exhibiting symptoms of depression for several months; she's also been dealing with the effects of a benign brain tumor which was recently removed via surgery. (Perhaps the two are related, perhaps not; I have no idea.) Today, during one of her post-surgery follow-up visits, she spoke to a social worker about her depression; the social worker said she was suicidal and needed immediate care, and had her admitted to Bellevue in NYC.

My parents are understandably concerned at the quality of care my sister might be receiving at Bellevue; they aren't sure if they should let her stay there, or have her transferred to another hospital. (They won't release her to my parents, but they'll allow a transfer via ambulance.) Is Bellevue a safe, reasonable place for my sister to be receiving psychiatric care? Would someplace else be better? Is there anything my parents should watch out for? (My mother, in particular, is quite upset that she can't stay with my sister and watch out for her welfare.)

While we're originally from New York, my wife and I reside in Chicago; we can't do much from here, but we can at least query the wonderful hive mind for some advice to pass along to my parents. ::hugs hive mind::

posted by korpios to health & fitness (13 comments total)

Years ago, I visited a friend's wife who was staying in Bellevue after a nervous breakdown. It seemed like a reasonable place. The section she was in was for patients who were dealing with nervous breakdowns and major depression, not psychotic breaks or anything like that. However, she was on the same floor as another section that housed people with more... vocal expression, and it was audible unless the door to her room was closed. I think it bothered her to hear the occasional outbursts from those patients.

I have no idea if the rest of Bellevue or the part of it in which your sister is housed are appropriate or safe now, but in any case it sounds like your parents should attempt to get a second opinion, even if they have to bring in an outside shrink. From the way you present the information, it sounds like the conditions of her admission to Bellevue are kind of iffy, so get another doctor in there to suss out the situation.

Best to your sister and I hope she is okay.
posted by bedhead at 9:03 PM on September 25, 2008

Do you know the duration of the psych hold? They are generally only 72 hours. Stressful, but not terribly long at least.
posted by 26.2 at 9:37 PM on September 25, 2008

Was your sister already in the care of a psychiatrist and a therapist? If not, your parents need to get to work to find competent people who are taking new patients so she will have care when she leaves the hospital. Having a good team (outside of the hospital) is much more critical to her long term care. I assume that she has doctors the family trust who are keeping on top of the side-effects of the tumor and surgery.

Your parents should call the nurses station, and ask how she is doing and what the current orders are. They should also ask if she has been evaluated by a psychiatrist yet and then how to get in touch with him/her to find out what the plan is. There should also be some times when they can call and when they can visit your sister. That will their chance to assess how she feels about the hospitalization. If she was actively suicidal, she might be relieved to be in a safe place and to have people take her suicidal feelings seriously.

In California, the adolescent psych ward is separate from the adult wards (which are much scarier than the teens). Also, adolescent beds are scarce so they tend to release patients as soon as they are stable.

Best wishes to your family.
posted by metahawk at 10:23 PM on September 25, 2008

How recent was the surgery? Where was the tumor? Exactly how old is she? Unless she is preternaturally upbeat there will be serious psychological ramifications when you open the skull of a teenager. Considering the location, she should be at a major children's hospital.
posted by rotifer at 10:51 PM on September 25, 2008

I don't think there's any way to answer this without you or your parents going out there to see what kind of situation she's in and getting a second opinion from a doctor you know and trust. Furthermore, what does your sister want? You may also need a lawyer in case they're trying to involuntarily commit her (which is a legal proceeding).
posted by footnote at 4:58 AM on September 26, 2008

Agree with advice above, but want to stress in response to the comment above that only in extreme cases of depression would a psychiatric ward/hospital attermpt to involuntarily commit someone (based on experience working in these settings). Usually a person who inspires commitment proceedings is either completely psychotic or rabidly and frankly suicidal (a "no-brainer" situation). Bases on the original post, neither appears to be the case. I would not recommend hiring a lawyer.
posted by dreamphone at 5:33 AM on September 26, 2008

One of my best friends did a psychiatric rotation at Bellevue, and the standards of care there are just fine. That said, it's an older facility and the patient pool includes some folks with serious issues (homeless New Yorkers).

If your parents can move your sister to another facility that has a patient pool made up primarily of people whose health insurance is footing the tab, that would probably be good. Bellevue does a great job in serving low-income and no-income folks with very serious illness, but a 17-year-old girl with major depression may find interacting with that patient population overly stressful.
posted by Sidhedevil at 8:05 AM on September 26, 2008

I'm in agreement with dreamphone. Involuntary hospitalization for suicidial ideation usually involves a very serious threat, which I'm not getting from your post.

A suicide assessment usually involves three things - Current Plan; Prior Attempts; and Resources (CPR). Under Current Plan, there are three things being looked at - Lethality of planned method (faster acting methods are higher risk); Availability of means (if the planned means are at hand, risk increases); and Specificity (has she done any preparation in terms of a planned time, written a note, given things away, etc). Any prior attempts by either your sister or a family member also increase the risk. Having lots of resources (family, friends, services, etc) can mitigate the risk, just as not having them can increase it.

I tell you all this because I think your family needs to ask some questions about the nature of the threat - I'm guessing she wouldn't be hospitalized just for admitting that she sometimes thinks about killing herself and that she expressed a credible plan. Given that your sister is a teenager (by which I assume a minor, and that your parents have responsibility for her care after discharge) and that this involves a threat of suicide, there should be some caveats on her confidentiality. Your family will need to know this in order to be able to provide care for her once the hold is over.

I know I'm not answering your direct question about Bellevue, which I can't speak to. But suicide threats need to be considered seriously, and having more information and frank conversations is going to be important. I'm hoping telling you how suicide assessments generally work will help in asking the right questions and determining the best course of action.

Best wishes for your sister and your family.
posted by never used baby shoes at 8:35 AM on September 26, 2008

Mental hospitals are in many regards prisons. Getting her out of there as soon as possible is the best course of action, especially if you think the admission was in error because she'll only go crazy with boredom and all the seemingly arbitrary restrictions.
posted by Electrius at 9:39 AM on September 26, 2008

I read that story about how one of the patients ended up killing a doc who was working there late at night, which is not really why I would suggest you get her out of there. It will probably scare her and make her depression even worse. Furthermore, she won't trust you guys anymore for making her stay there. I've also read that it's one of the worst places in the world by a relative who is a psychiatrist and chose not to do her residency there within fifteen minutes of entering the building for her interview. She said people there are flat out deranged.

Has your sis expressed suicidal thoughts in the past? The social worker might have just overreacted because she's professionally obligated to.
posted by onepapertiger at 12:07 PM on September 26, 2008

More information:

- My sister is 15. (Or is it 16? I always forget my siblings' years of birth.)

- The surgery was in June; it was performed at NYU by an excellent surgeon, and there were no immediate complications. (My parents are fanatics about quality-of-care.)

- It turns out that this was voluntary on my sister's part; even though my parents have been working to find her a therapist and psychiatrist (she's seen two therapists so far who didn't click), my sister essentially decided she wanted to be taken right-then-and-there. She's not making this easy for my parents. I know this invalidates some of the advice given, since there was an assumption that this was involuntary (with regards to my sister, anyway; my parents would have rather handled this closer to home in upstate NY).

- While firm about the rules, the staff at Bellevue has been polite with my parents thus far in discussing treatment, etc.

Thanks for the advice; I had my mother read it (the latest post at that point was by never used baby shoes), and she's already done most of the suggested actions. She should be visiting my sister now; visiting hours are strangely late (beginning at 3pm ET).
posted by korpios at 2:21 PM on September 26, 2008

While Bellevue is a fine institution, your family should probably look into getting your sister transferred to Mt. Sinai Hospital in uptown Manhattan. They have one of the only adolescent-specific mental health wards in the city -- most other hospitals only have a pediatric ward and/or an adult ward. Their doctors' contact list (from 2006, though) is here (PDF) Mt. Sinai also has a brain tumor center, which could be especially helpful in your sister's case. Best of luck to you.
posted by Asparagirl at 3:29 PM on September 26, 2008

In regards as to why it's late, if it's at all similar to the facility I visited (not necessarily probably), often the medication people get in the morning makes them either zombies for the next few hours, or really screw with their behaviour and affect. Not kidding, and I'd use it as a reason if I were them, and also, it wouldn't be lunchtime because that can... also be a bit dramatic.

That's an aside though. For your sister, just being her visitor is good, and DO NOT try and 'talk' her out of her depression, or minimise it's effect. DO just ask her how she is, how she's finding the ward etc, and *empathise* with her feelings on it. Don't try and reason or anything, just, if it's negative, say you're sorry she's feeling *blah*, that you're feeling pretty worried about her too, but that you're here if she needs you or needs anything. If good, like 'I think I'm getting my head into place', then express your praise for the positive points.
Urgh, that's way too long. Sorry, yeah. Eympathise before reasoning, or just skip the second bit. If you're conveying information, still take a moment to empathise, then move on.
posted by Elysum at 5:21 AM on October 5, 2008