What can I expect from the psych ER in NYC?

June 14, 2009 7:16 PM

I've been suffering from severe depression and told my therapist that if I feel any worse, I will go to the hospital and tell them I am thinking of hurting myself. In New York state, what can I expect from this experience?

I've been severely depressed and my therapist said if I ever feel any worse than I do now the next step is to go to the hospital. From everything I've heard people who go to the ER for psychiatric reasons have a horrible experience--I'd like to know exactly what I would expect if I went to the ER here in NYC and said, "I've been having suicidal thoughts, and I've been hurting myself." I am NOT in any imminent risk and am back from the brink, but if I get back to that bad place again I feel it might be good to know what I'm in for.

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

If you're having suicidal thoughts than please go to a friends, go anywhere you feel comfortable, and if you think you need to than go to the ER. Don't let someone else's bad experience keep you from getting treatment, even if their experience was horrible it might still have saved their life. Good luck to you.
posted by BrnP84 at 7:52 PM on June 14, 2009

This looks to be a 211-page manual for emergency room personnel as to how they should handle incoming adolescent suicide attempts, although that may not match your age group and doesn't appear to be New York-specific.

The general "NYC psychiatric ERs suck!" vibe that you speak of may be a direct result of the very splashy July '08 news story about Esmin Green – in which case I might suggest that other facilities might be far better than what happened to poor Ms. Green. As with many large-city emergency rooms, you may have a wait.

This hyperlinked Google search for "New York City" "psychiatric emergency room" may yield research points for you.

It appears there was an article, "Profile of a Comprehensive Psychiatric Emergency Program in a New York City Municipal Hospital," in a professional journal, but that it is not available online for free; its price isn't immediately clear on the page.

I commend you for having the courage to prepare yourself for this, although I of course hope you never need implement it. But not shying away from uncomfortable possibilities, so that you continue to thrive – that sounds like (in my entirely non-expert, layman, joe-on-the-street opinion) a sign of health. I wish you the best ...
posted by WCityMike at 8:02 PM on June 14, 2009

I'm not sure what they're called in NYC but in Philly there are psychiatric emergency rooms called Crisis Response Centers where as soon as you walk in the door you will be immediately in contact with psych nurses, social workers and psychiatrists and triaged for transport to an inpatient facility. If you know in advance that you may need to voluntarily commit yourself to a psych facility you should get a listing of psych emergency rooms and know where the nearest one is. The wait for transport to an inpatient facility can take a considerable amount of time depending on a number of different factors, and during that time you will be surrounded by other people in a state of psychiatric emergency, some of whom may be brought in by police for involuntary commitments, may be strapped to gurneys, stuff like that. It can be intense, and inpatient stays at psychiatric facilities can be similarly intense as you'll be surrounded by people with all kinds of varying levels of severity in disorders, some psychotic, some maybe coming directly off the streets, etc. However, if you are seriously in danger of hurting yourself you'll benefit from the high level of supervision that you'll receive in one of these facilities.
posted by The Straightener at 8:07 PM on June 14, 2009

This wasn't in New York or even an urban hospital (it was more suburban and I think entirely voluntary). I know someone who did this. I visited them a few times - they were there for 3 or 4 days. It was bleak, but I wouldn't describe it as awful - all of the patients were in a locked/secure wing and were under supervision for suicide or hurting others. The day was regimented - meals, therapy, groups, journaling, workbooks, reading. I don't know much about medication or anything like that.

I think more than anything, spending all of that time around some of the other patients made them realize that it could be far, far worse.
posted by milkrate at 8:10 PM on June 14, 2009

Getting checked into a hospital on an involuntary form can be anything from a life affirming and life saving event, to a hellish prison that makes everything worse. It all depends on the hospital and the staff you encounter.

BUT... If you're potentially going to die if you don't go in, surely it's worth the risk!

Anyway, if you go in and say something like "I've been having suicidal thoughts, and I've been hurting myself" then they have a legal obligation to check you in for three days (if it's the same as Ontario), during which you'll be observed/interviewed/etc. and potentially be on suicide watch if they assess you as high risk. At the end of three days, you'll either get put in a thirty day in-patient program, or they'll work with you for alternate treatment if they consider you lower risk.
posted by glider at 8:11 PM on June 14, 2009

Btw, Anon, I've been in a number of different psych emergency rooms and inpatient facilities as a social worker, you can feel free drop me a line if you have any other more specific questions.
posted by The Straightener at 8:12 PM on June 14, 2009

I took my boyfriend (well, at that point he was my ex-boyfriend) to the ER once when I was worried he would hurt himself. I had to fill out the intake forms forms for him because he wasn't in a state to do it. As soon as I told them I thought he was at risk of harming himself, someone came out to evaluate him, there was no wait.

They determined, through interviews that I was not present for, that they did not need to admit him, and in general weren't too helpful beyond that. I can not speak about what it would be like to be admitted.
posted by mai at 8:23 PM on June 14, 2009

comment from a MeFite who would prefer to remain anonymous

FWIW, here's my experiences at three different normal/mental hospitals in NJ, two public and one private:

Pack a bag of important stuff. Phone card (they only have one pay phone in psychiatric wards and hospitals so they can control what calls go in and out), clothes, toiletries, anything you need to make your stay not horrible (I brought a notebook). If you find yourself in the ER with only the clothes on your back, call a relative to pack and bring a bag over for you.

If you have the presence of mind to be able to make a call to your insurance company, do it. If you don't, have a friend do it. They can be real bitches: "Oh you didn't notify us before you went to ER, we're not paying." It's good that you've already told your counselor; that shows a real awareness of where you and what you're feeling and a recognition that you can be a danger to yourself.

Bring someone along who you trust and are close to. Unless you are seriously bleeding and need critical care (please don't get up to that point), don't be suprised if they make you wait for hours before you are checked in. In the state you are in, time will not be kind and you shouldn't have to suffer a mite more than you have to by listening to the thoughts in your head. Having a friend along to talk to will make that experience easier.

Once you are checked in, you may or may not get sent to the psychiatric ward. (Your friends and family won't be able to visit until visiting hours now.) This depends on how full they are. In NYC, I'm betting they are going to be pretty full (all my experiences were in urban areas, it was the same there). If you don't get sent to psychiatric, you'll still get a normal bed and meals, and then get to sent to psych.

Once you get to the psych ward, a nurse will be around to take down all your info, get your physical stats (blood pressure, etc.), medical history, etc. They'll check your bag to make sure you didn't pack anything dangerous to yourself or others and take them away. They'll also take away any meds you've brought, including psych ones. For the next couple days, they'll be the ones in charge of doling them out. They'll also take away cell phones, other things, etc. Don't wear shoes with shoelaces; they'll take them away because you might use them to hang yourself.

That'll be check-in day. The staff psychiatrist may do a full interview with you that day or the next. Depending on space, insurance, other circumstances (i.e. refusing to take meds got me involuntarily committed and sent to another hospital), etc. you may or may not be transferred to another mental hospital. It'll be in an ambulance, you'll be on a stretcher (to cover legal purposes, really. I don't think you'll be thrashing around). If it's involuntary commitment, you'll be strapped down, but not in a "let's control the crazy person way", again for legal purposes. Wherever you end up, try to get a good night's sleep that night. They usually hand out Trazadone (sp?) to anyone who wants it to help them sleep.

Staff usually leave you alone the first day you're there. Most patients sleep because they are pretty exhausted. Breakfast, lunch, and dinner are at set times, some hospitals may have group activities (you're not *forced* to go, but orderlies can be insistent about it sometimes; it's seen as a sign of good/improving health if you start socializing and are able to talk about what you're going through). AA and NA meetings will be available.

There's no need to be scared of the other patients. I've never come across a violent patient (or one who was violent *in* the hospital) and even the ones who were "crazy and babbling" calm down once their meds kick in. I doubt there will be many conflicts between you guys. Most people are too focused on the shit going on inside their own heads to start trouble with others. On the whole, other patients are friendly and supportive, you'll make temporary friends :-) I find there's two types of patients: the ones who want to get out really fast, and the ones who don't want to leave (because they have no place to go to).

Important points:

1. You should know that once you check in as a psych patient *it will be a long process before they let you walk out*. My third stay I left AMA (against medical advice) but since I was there voluntarily they *did* let me out, about 24 hours after I filled out the form to be discharged. My first time was involuntary; you do the math.

2. Also, in NJ you can't just check into certain mental hospitals. They require you to go to a normal hospital's ER first and get transferred over. I'm not sure how it is NYC.

YMMV points:

Some of the orderlies can be dicks. Don't worry, not in a Nurse Ratchet way. But it's amazing how different their experience of a mental hospital is from yours. I've endured a few incredibly condescending lectures from well-meaning orderlies looking down their nose at me, and it's been the same with some other patients. "Let me tell you what I've been through but I've never ended up in a mental hospital." Really tells you who they think they're dealing with, eh? They think they're being encouraging. But they're just missing an empathy chip. Ignore them. Most of the orderlies are kind and don't have anything to prove.

Really, I hope the best turns out for you. When you get out, don't be surprised if things don't turn around right away. Be patient with yourself. You don't have to prove your "spritual strength" to anyone. I have no idea what you've been through and everybody's got a different path. It'll take time and I wish you the best. Things will get better, even if it's slowly. EVERYTHING WILL BE OK.

posted by jessamyn at 9:01 PM on June 14, 2009 [10 favorites]

You'll be interviewed by a triage nurse, then probably taken back to a room in the ER to wait for nurses--blood draws, urine samples, an interview with a psych resident. If you're concerned that once there you will not be honest and that will be to your own detriment, have someone you trust come with you. The room will probably have a camera in it and a guard posted at the door. If they determine you are at risk, they will try to find you a bed for a 72-hour hold. There may or may not be a bed in that facility; if there is, your transfer will be quick. If not, you could be taken anywhere there's room available. In some systems, it may a couple days before you're allowed to see family or friends.

In many places you're then interviewed further--in New Orleans, it's by the parish coroner--to determine whether there is legal ground to hold you longer. If you're admitting yourself voluntarily, you could be held for a much longer period--here, it's 15 days. Once you voluntarily admit yourself, you cannot leave until the commitment period is over.

On the whole, observing someone going through this at 4 different facilities? It can be dehumanizing. It also, however, keeps you safe.

You may not feel appreciably better at the end of the commitment period, because if they're starting you on new drugs they won't be fully active in your system yet. You'll probably be referred to outpatient treatment or a partial hospitalization program in addition to your regular therapy.

Mefimail me if you have more questions. This has been my life recently.
posted by liketitanic at 9:05 PM on June 14, 2009

I don't have a ton of experience but do work occasionally on a locked ward. I've gotten to go on rounds where patients are interviewed by the medical team (doctor, nurse and social worker). I have to say, for the most part the team is really looking out for the needs of the patient as best they can. Particularly in cases of depression where it's somewhat clear what the problem is (with schizophrenia it's a lot harder to understand what is going on).

But the interesting thing to me is that even though it's a locked ward and people are missing their freedom, none of the maybe 30 interviews I've been on have the patients been like "get me out of here now!!!" Actually not at all. Some are frustrated, and are looking for a discharge date but most everyone seems to understand why they are there. They are asked every day if they feel safe and if it's a good place for them there and they all say they do.

Not sure if that's helpful but it sort of surprised me. This is a really well respected psych hospital.

My understanding is that you have 3 days to voluntarily leave if you voluntarily enter. After that, you have a commitment hearing and if the judge agrees to you staying, then you stay until the staff thinks you're well enough to go.

Good luck. Sounds like you are moving past this being an issue but I don't think it's horrible in the sense that you are thinking. Perhaps you should do some research into where you'd go if you needed to go.
posted by sully75 at 3:10 AM on June 15, 2009

2. Also, in NJ you can't just check into certain mental hospitals. They require you to go to a normal hospital's ER first and get transferred over. I'm not sure how it is NYC.

In Philly these determinations are made based solely on bed availability, the psych emergency rooms have a sort of gate keeper function that is part of the triage process where after you sign yourself into the system they start calling the Department of Behavioral Health to figure out where to put you. So, no, in Philly you also can't sign into a particular psych facility in a big city psych hospital system, it's sort of luck of the draw past intake. You could wind up on Founders 11 at UPenn's hospital which is downright chi-chi compared to say Mercy Hospital in Southwest Philly, which is pretty close to your stereotypical horror movie psych unit, but you won't know what to expect until you arrive if you're not familiar with the system. Location is not necessarily a determination of quality, for instance you might the psych unit on Temple's Episcopal Hospital campus would be harrowing because the hospital itself is in the heart of the Badlands but it's not, the pscyh unit there is totally fine. Mostly, they're just like any hospital ward, at least the good ones are indistinguishable from any other part of the hospital.

My understanding is that you have 3 days to voluntarily leave if you voluntarily enter. After that, you have a commitment hearing and if the judge agrees to you staying, then you stay until the staff thinks you're well enough to go.

Actually, if you are involuntarily committed you have 3 days of initial observation during which you cannot leave, after this initial 72 hour lock down you see a judge in mental health court, who determines with the help of hospital staff and your appointed attorney whether or not you stay longer. Voluntary commitments don't go in front of judges, they don't need to because they aren't being held against their will.
posted by The Straightener at 5:46 AM on June 15, 2009

If your insurance and/or your resources allow you to go to one of the expensive private places, by all means do it. Many years ago, my mom was in the one in Westchester that's affiliated with Cornell Medical School/New York Hospital, I forget the name. Beautiful setting and great care. It looked more like a retreat than a hospital.

Once you've identified a hospital that you think you might feel comfortable staying in for a few days or a few weeks should the need arise, see if they have some kind of out-patient programs, therapy, groups, etc. and try those. Then if you do ever feel like you have to be in the hospital you will already be in their system and might not even need to do the harrowing ER thing.

In the meantime, make sure you get plenty of exercise and sunlight, both can help enormously.
posted by mareli at 10:05 AM on June 15, 2009

I'm so sorry you're having such a rough time. This article has been a great help to me, and I hope it may be of interest to you. Please stay safe.
How Not To Commit Suicide
posted by theora55 at 11:41 AM on June 15, 2009