How to advocate for my girlfriend in inpatient psychiatric care?
November 6, 2014 3:34 PM Subscribe
My girlfriend recently had an instance alone where she contemplated (but did not attempt) suicide. It was the first time she'd experienced what she now recalls as a hallucination. She saw a psychotherapist 2 days afterwards to discuss options. After talking with the therapist, she decided to check in for inpatient psychiatric care (and arranged it for the same day).
How can I be the best advocate for her health right now?
TL;DR: my girlfriend voluntary checked into inpatient psychiatric care. What are the best things I can do to help?
(I saw some good suggestions regarding visiting and bringing interesting things in via this previous question)
She's long been on a mild dose of antidepressant medication to treat generalized anxiety, which really helped treat her anxiety. She hasn't yet had her first full consultation with a doctor at the inpatient facility, but they've already let her know they're going to prescribe a drug that's generally used to help treat schizophrenia and bipolar disorder.
I really don't like the idea of inpatient psychiatric care because it seems extreme: locked doors, no shoelaces allowed, specific visitation hours, fear of the effects and side effects of these types of drugs. But even scarier to me is even the remote possibility of losing my girlfriend to suicide, something I had never imagined would be a challenge for her. I was present for her consultation with the therapist, and it's clear to me that she arrived at this decision (inpatient care) by herself.
Fortunately she's extremely interested in getting help, and I want to do whatever I can to help. She has a lot of emotional baggage around these challenges, to the point that she doesn't feel like she can go to her family for support (as they see psychiatric issues as a sign of personal failing or inadequate religious observance).
So far, I've provided emotional support and reassurance that these feelings are temporary and can go away, and that she's facing a challenging health issue and not a personal failing. My heart breaks that she can't hear that from her own family. I've also tried to be present whenever possible to take notes and provide contextual information. I think the experience is pretty overwhelming for her, and I've noticed that she's not communicating details as well as she usually does, including in some very important areas (e.g. making sure the nurse understands "I thought about using a knife to cut my wrists and that's why I'm here" and not "I have a plan to use a knife to cut my wrists").
My perfect world? She has her consultation with the doctor, he increases her dose of existing antidepressant or something, refers her to a therapist, sends her home the same day and she never has to deal with that type of experience again.
However, I'm aware it might not go that way.
What are the best things I can do to help here? I feel like her just being in a locked down place like that is going to make it harder for her to feel like her normal, competent self. Please help me determine the best way to advocate for her and help her through this, while she's in there and after she's out.
TL;DR: my girlfriend voluntary checked into inpatient psychiatric care. What are the best things I can do to help?
(I saw some good suggestions regarding visiting and bringing interesting things in via this previous question)
She's long been on a mild dose of antidepressant medication to treat generalized anxiety, which really helped treat her anxiety. She hasn't yet had her first full consultation with a doctor at the inpatient facility, but they've already let her know they're going to prescribe a drug that's generally used to help treat schizophrenia and bipolar disorder.
I really don't like the idea of inpatient psychiatric care because it seems extreme: locked doors, no shoelaces allowed, specific visitation hours, fear of the effects and side effects of these types of drugs. But even scarier to me is even the remote possibility of losing my girlfriend to suicide, something I had never imagined would be a challenge for her. I was present for her consultation with the therapist, and it's clear to me that she arrived at this decision (inpatient care) by herself.
Fortunately she's extremely interested in getting help, and I want to do whatever I can to help. She has a lot of emotional baggage around these challenges, to the point that she doesn't feel like she can go to her family for support (as they see psychiatric issues as a sign of personal failing or inadequate religious observance).
So far, I've provided emotional support and reassurance that these feelings are temporary and can go away, and that she's facing a challenging health issue and not a personal failing. My heart breaks that she can't hear that from her own family. I've also tried to be present whenever possible to take notes and provide contextual information. I think the experience is pretty overwhelming for her, and I've noticed that she's not communicating details as well as she usually does, including in some very important areas (e.g. making sure the nurse understands "I thought about using a knife to cut my wrists and that's why I'm here" and not "I have a plan to use a knife to cut my wrists").
My perfect world? She has her consultation with the doctor, he increases her dose of existing antidepressant or something, refers her to a therapist, sends her home the same day and she never has to deal with that type of experience again.
However, I'm aware it might not go that way.
What are the best things I can do to help here? I feel like her just being in a locked down place like that is going to make it harder for her to feel like her normal, competent self. Please help me determine the best way to advocate for her and help her through this, while she's in there and after she's out.
The best way you can visit her is to find out when you can visit, and visit. Find out when she's allowed to make calls, and be by the phone.
If they'll let you join them for meals, join them for meals and meet the friends she's making in there.
posted by colin_l at 3:49 PM on November 6, 2014 [2 favorites]
If they'll let you join them for meals, join them for meals and meet the friends she's making in there.
posted by colin_l at 3:49 PM on November 6, 2014 [2 favorites]
Most hospitals have visiting hours every day (usually for 1-2 hours) and you can bring them news about outside. Although, most of it is providing support as in reminding the other person this is not a personal setback or problem which will never be solved. If she likes reading books then it's a good idea to bring books as most forms of entertainment is limited to a common room or group activities.
Depending on your country or state there are guidelines which can help inpatients and their friends/families about their treatment plans and stay.Unfortunately, the actual length of the stay can vary greatly unless she were to receive a doctor's permission to be discharged by a certain time.
For bringing guests it's a good idea to ask the person if she will be fine with them showing up during visiting hours. Also, if you have any other questions feel free to PM me here.
posted by chrono_rabbit at 3:51 PM on November 6, 2014 [1 favorite]
Depending on your country or state there are guidelines which can help inpatients and their friends/families about their treatment plans and stay.Unfortunately, the actual length of the stay can vary greatly unless she were to receive a doctor's permission to be discharged by a certain time.
For bringing guests it's a good idea to ask the person if she will be fine with them showing up during visiting hours. Also, if you have any other questions feel free to PM me here.
posted by chrono_rabbit at 3:51 PM on November 6, 2014 [1 favorite]
In my personal experience one of the worst aspects of inpatient psych care is the food. Really bad. I was especially grateful if visitors brought treats for me. You need to check the staff first, but take-out at meal time or sweet or savory treats she can keep labeled in the fridge or a cabinet would probably be greatly appreciated.
And, yeah, magazines if she's into them, puzzles, sudoku, crosswords, books, etc. are all great, depending on her taste. It's common for people undergoing a mental health crisis or with depression or anxiety to have problems concentrating, so maybe lighter, shorter reading material would be best. She might also be allowed nice toiletries, if she's into that. Sometimes the unit will allow things like lotion, but it must be kept in a locked cabinet and asked for. But something that smells really nice can be soothing.
posted by primate moon at 4:00 PM on November 6, 2014 [1 favorite]
And, yeah, magazines if she's into them, puzzles, sudoku, crosswords, books, etc. are all great, depending on her taste. It's common for people undergoing a mental health crisis or with depression or anxiety to have problems concentrating, so maybe lighter, shorter reading material would be best. She might also be allowed nice toiletries, if she's into that. Sometimes the unit will allow things like lotion, but it must be kept in a locked cabinet and asked for. But something that smells really nice can be soothing.
posted by primate moon at 4:00 PM on November 6, 2014 [1 favorite]
I meant to include this link to a story published this week, written by a woman who pretty abruptly started having delusions, about her experience. It is specifically important to notice that she wasn't okay just because she was released. It took months - back at work, living at home, but really very much not okay - to get back to a reasonably non-delusional brain state.
posted by Lyn Never at 4:01 PM on November 6, 2014 [5 favorites]
posted by Lyn Never at 4:01 PM on November 6, 2014 [5 favorites]
Yes. The best thing you can do is visit. Bring her what she needs or asks for if it is allowed. Be by the phone. Call if that's allowed. Let her explain and describe things to her providers.
Mental health is a tough one. It's not like cancer where having a second person there during appointments as a set of ears and as an advocate really works. This is about her thoughts and feelings and reality. While with most other health issues being by her side would be exactly the right thing to do - your impulse there is good - that's just not as much the case here with inpatient psychiatric care.
You sound like you really care for her and want the best. You're a good boyfriend. Take care of yourself right now because that's important too - a good way to be there for her is to make sure you are well fed and rested and functioning. Visit and do what you can to provide emotional support for her. I wish you both the best.
posted by sockermom at 4:05 PM on November 6, 2014 [5 favorites]
Mental health is a tough one. It's not like cancer where having a second person there during appointments as a set of ears and as an advocate really works. This is about her thoughts and feelings and reality. While with most other health issues being by her side would be exactly the right thing to do - your impulse there is good - that's just not as much the case here with inpatient psychiatric care.
You sound like you really care for her and want the best. You're a good boyfriend. Take care of yourself right now because that's important too - a good way to be there for her is to make sure you are well fed and rested and functioning. Visit and do what you can to provide emotional support for her. I wish you both the best.
posted by sockermom at 4:05 PM on November 6, 2014 [5 favorites]
To follow on the heels of what Lyn Never said:
I really don't like the idea of inpatient psychiatric care because it seems extreme: locked doors, no shoelaces allowed, specific visitation hours, fear of the effects and side effects of these types of drugs.
You could say the same thing about, say, someone in the hospital for a bone marrow transplant. Isolation, controlled visiting hours because of the immune system effects, medications with terrible side effects.
You have got to reframe this in your head. Your girlfriend is in the hospital for a medical issue. It doesn't matter what medical issue it is or what kind of hospital it is. If you can't honestly reframe this in your head, and make yourself consider this as any other medical issue, without the cultural baggage and judgement we've all been raised to give mental health issues, then you're going to have a really hard time with this (harder than it is already).
My perfect world? She has her consultation with the doctor, he increases her dose of existing antidepressant or something, refers her to a therapist, sends her home the same day and she never has to deal with that type of experience again.
I know you said, "However, I'm aware it might not go that way", but you need to prepare for the idea that it's not going to go that way. False hope here is unrealistic; mental health issues are often ongoing and require ongoing management. And they're unpredictable - things will be fine fine fine good fine fine good great fine and then terrible off the cliff. I know this wasn't your question, but if you stay, you acknowledge that this can happen again - and you stay anyway.
My wife and I have been together a little over a year, and there's been a lithium toxicity incident, a reaction to Tamiflu that resulted in a psychotic break, and most recently a trip to the ER because she was suicidal. It's hard, and it sucks. Life with her is still far better than life without her. So I stay.
So... work on the framing in your head, make sure that you believe you can deal with things if this happens again (and lots of folks can't, and there's no shame in that necessarily - but sooner than later, to figure that out), and in the meantime, what everyone else said: visit as much as you can, ask her what she needs, be there to take her home when she's released.
Hang in there.
posted by joycehealy at 4:21 PM on November 6, 2014 [16 favorites]
I really don't like the idea of inpatient psychiatric care because it seems extreme: locked doors, no shoelaces allowed, specific visitation hours, fear of the effects and side effects of these types of drugs.
You could say the same thing about, say, someone in the hospital for a bone marrow transplant. Isolation, controlled visiting hours because of the immune system effects, medications with terrible side effects.
You have got to reframe this in your head. Your girlfriend is in the hospital for a medical issue. It doesn't matter what medical issue it is or what kind of hospital it is. If you can't honestly reframe this in your head, and make yourself consider this as any other medical issue, without the cultural baggage and judgement we've all been raised to give mental health issues, then you're going to have a really hard time with this (harder than it is already).
My perfect world? She has her consultation with the doctor, he increases her dose of existing antidepressant or something, refers her to a therapist, sends her home the same day and she never has to deal with that type of experience again.
I know you said, "However, I'm aware it might not go that way", but you need to prepare for the idea that it's not going to go that way. False hope here is unrealistic; mental health issues are often ongoing and require ongoing management. And they're unpredictable - things will be fine fine fine good fine fine good great fine and then terrible off the cliff. I know this wasn't your question, but if you stay, you acknowledge that this can happen again - and you stay anyway.
My wife and I have been together a little over a year, and there's been a lithium toxicity incident, a reaction to Tamiflu that resulted in a psychotic break, and most recently a trip to the ER because she was suicidal. It's hard, and it sucks. Life with her is still far better than life without her. So I stay.
So... work on the framing in your head, make sure that you believe you can deal with things if this happens again (and lots of folks can't, and there's no shame in that necessarily - but sooner than later, to figure that out), and in the meantime, what everyone else said: visit as much as you can, ask her what she needs, be there to take her home when she's released.
Hang in there.
posted by joycehealy at 4:21 PM on November 6, 2014 [16 favorites]
Do you have anyone that you're talking to right now about this? I ask because this sounds like an event that you both might want to keep relatively quiet for privacy reasons, but that might leave you with not a lot of people you could talk candidly about your own feelings at what must be a really tough time for not just your girlfriend, but also you. In addition to all of the above advice on being supportive, making sure that you give yourself space to work through your own feelings on this could be very helpful, if for no other reason than that the person you'd normally talk to about something this intense and life-impacting would be your girlfriend... but she really can't be your audience right now, for obvious reasons.
Good luck & take care of yourselves.
posted by deludingmyself at 5:28 PM on November 6, 2014 [4 favorites]
Good luck & take care of yourselves.
posted by deludingmyself at 5:28 PM on November 6, 2014 [4 favorites]
I worked at a short term psychiatric hospital for a few years as a CBT counselor. Your girlfriend needs to know that you love her and are here for her. This means supporting her medical plan, supporting her in-patient therapy, supporting her day treatment therapy, and supporting her medication regime when she gets home and her supporting her through the on-going struggle with mental illness. You don't really get a say for what is best for her unless she is clearly in danger of hurting herself or others. She was smart and amazing and brave for seeking out treatment for suicidal thoughts/hallucinations. This is not something to be shamed, but to be celebrated since she knew herself so well to know this is not normal and took action towards making it better.
To support her during her in-patient stay.
1.) Call the nurses station and find out what you are allowed to bring and when visiting hours are. We inventory everything that comes into the unit so the patient knows what they have and what they should leave with. Be prepared for nurses to want to go through everything and write it in a log the second you walk in the door. Don't bring pens, as the usually are not allowed. Books, magazines, sudoku are all great suggestions. No electronics .
2.) Patients spend A LOT of time in groups, meetings, one on one's with doctors/nurses/social workers. She may not want to talk about all the problems and issues she deals with from 9-5 again with you during visiting hours. Be prepared to talk about light fluffy stuff. Do not think she isn't working through her issues in therapy - but there are only so many times you can repeat yourself and sometimes you need a break and feel like your normal self to BE your normal self.
3.) Patients spend A LOT of time in groups, meetings, etc - know when to call to be able to talk to her. Some facilities only allow outgoing local calls. Find out if she can call you, or if you have to call her. Try to set up a time when to call ahead of time if you can't come and visit during visitation hours. Be patient if the phone lines are busy. We had 3 phones for 24 patients - sometimes it can take a bit for the lines to open up.
4.) Check with the nurses staff if you are allowed to bring outside food on the unit. Mine did not - as we were first a hospital, and some patients had diabetic diets, low salt, MAOI specific diets, that specific foods could cause bad interactions with her medication if she eats something she shouldn't. If they allow you to bring food - ask if there is anything you shouldn't bring.
5.) Don't get hung up on the drugs prescribed to her. Sometimes Seroquel (which is usually prescribed for schizophrenics/ bi polar disorder with psychotic features) is given to depressives to help them sleep. Sometimes antipsychotics are given to depressives to stop ruminating thoughts. There are off label uses for drugs that you may not know. I am assuming you are not a medical doctor, and even if you are you are not HER medical doctor - trust that your girlfriend is working with her therapist and her psychiatrist to get her back to functioning.
6.) Don't share ANY of your negative thoughts and feeling about her being inpatient. She is clearly having a difficult time, the LAST thing that should be on her mind is pleasing you/making you feel better about her decision.
Bottom line, the best thing you can do to advocate for her is to support her. She is dealing with a lot right now, and in patient hospitalization can be scary. She needs to know that this was the right decision, that you like her decision, and that getting her stabilized in a controlled environment was the absolute right choice for her.
It's hard on the family of patients too. If you are VERY close with your girlfriend (long time life partners close) see if she will sign a HIPAA release form for you, so the hospital staff can even acknowledge that she is on the unit when you call, and talk to you about her long term treatment plan.
MeMail me if you need anything else.
posted by Suffocating Kitty at 5:42 PM on November 6, 2014 [11 favorites]
To support her during her in-patient stay.
1.) Call the nurses station and find out what you are allowed to bring and when visiting hours are. We inventory everything that comes into the unit so the patient knows what they have and what they should leave with. Be prepared for nurses to want to go through everything and write it in a log the second you walk in the door. Don't bring pens, as the usually are not allowed. Books, magazines, sudoku are all great suggestions. No electronics .
2.) Patients spend A LOT of time in groups, meetings, one on one's with doctors/nurses/social workers. She may not want to talk about all the problems and issues she deals with from 9-5 again with you during visiting hours. Be prepared to talk about light fluffy stuff. Do not think she isn't working through her issues in therapy - but there are only so many times you can repeat yourself and sometimes you need a break and feel like your normal self to BE your normal self.
3.) Patients spend A LOT of time in groups, meetings, etc - know when to call to be able to talk to her. Some facilities only allow outgoing local calls. Find out if she can call you, or if you have to call her. Try to set up a time when to call ahead of time if you can't come and visit during visitation hours. Be patient if the phone lines are busy. We had 3 phones for 24 patients - sometimes it can take a bit for the lines to open up.
4.) Check with the nurses staff if you are allowed to bring outside food on the unit. Mine did not - as we were first a hospital, and some patients had diabetic diets, low salt, MAOI specific diets, that specific foods could cause bad interactions with her medication if she eats something she shouldn't. If they allow you to bring food - ask if there is anything you shouldn't bring.
5.) Don't get hung up on the drugs prescribed to her. Sometimes Seroquel (which is usually prescribed for schizophrenics/ bi polar disorder with psychotic features) is given to depressives to help them sleep. Sometimes antipsychotics are given to depressives to stop ruminating thoughts. There are off label uses for drugs that you may not know. I am assuming you are not a medical doctor, and even if you are you are not HER medical doctor - trust that your girlfriend is working with her therapist and her psychiatrist to get her back to functioning.
6.) Don't share ANY of your negative thoughts and feeling about her being inpatient. She is clearly having a difficult time, the LAST thing that should be on her mind is pleasing you/making you feel better about her decision.
Bottom line, the best thing you can do to advocate for her is to support her. She is dealing with a lot right now, and in patient hospitalization can be scary. She needs to know that this was the right decision, that you like her decision, and that getting her stabilized in a controlled environment was the absolute right choice for her.
It's hard on the family of patients too. If you are VERY close with your girlfriend (long time life partners close) see if she will sign a HIPAA release form for you, so the hospital staff can even acknowledge that she is on the unit when you call, and talk to you about her long term treatment plan.
MeMail me if you need anything else.
posted by Suffocating Kitty at 5:42 PM on November 6, 2014 [11 favorites]
"My perfect world? She has her consultation with the doctor, he increases her dose of existing antidepressant or something, refers her to a therapist, sends her home the same day and she never has to deal with that type of experience again."
The best thing you can do for her is to recognize that this isn't about you and your perfect world. She's experiencing hallucinations and something has concerned her enough to go inpatient. If you are staying with her, you need to recognize that this is the way it is. Her mental health may improve with medications, or it may take years to try and find a med that works for her. She will need your support. So many people won't get help for themselves when they are ill, she is to be applauded and not judged.
I have bipolar with psychosis. It took me 4 years to find a med that works for the mood symptoms. My psychosis comes and goes; I go on and off medications for that. I would like to just stay on a med, but I have not been able to find an anti-psychotic med that I can tolerate the side effects for long. Having hallucinations is scary. I feel very alone because I can't talk about them to many people; I sound so, well, crazy. It has been an incredible relief to have people who support me, even if they have never experienced it. They treat me like a normal human being while at the same time understanding I deal with this stuff. Your girlfriend needs this level of understanding: don't pretend that she's never going to experience it again.
posted by veerat at 6:53 PM on November 6, 2014 [9 favorites]
The best thing you can do for her is to recognize that this isn't about you and your perfect world. She's experiencing hallucinations and something has concerned her enough to go inpatient. If you are staying with her, you need to recognize that this is the way it is. Her mental health may improve with medications, or it may take years to try and find a med that works for her. She will need your support. So many people won't get help for themselves when they are ill, she is to be applauded and not judged.
I have bipolar with psychosis. It took me 4 years to find a med that works for the mood symptoms. My psychosis comes and goes; I go on and off medications for that. I would like to just stay on a med, but I have not been able to find an anti-psychotic med that I can tolerate the side effects for long. Having hallucinations is scary. I feel very alone because I can't talk about them to many people; I sound so, well, crazy. It has been an incredible relief to have people who support me, even if they have never experienced it. They treat me like a normal human being while at the same time understanding I deal with this stuff. Your girlfriend needs this level of understanding: don't pretend that she's never going to experience it again.
posted by veerat at 6:53 PM on November 6, 2014 [9 favorites]
I really don't like the idea of inpatient psychiatric care because it seems extreme
That's your issue to work out without your girlfriend, for the time being. The general model is to put the person who needs help in the center of the circle and then people close to them and then out from there. "comfort in, dump out" Ignore your perfect world, focus on your actual world and live within it.
The best things you can generally do are talk to other people about your concerns and feelings and show up for visiting hours with something tasty (or whatever your girlfriend's comfort items are that you are allowed to bring) and a willingness to listen, or just hang out, or whatever. It sounds like there's a lot of baggage in your girlfriend's life about mental health and you should work like hell to not add to that. Be a good listener. Educate yourself. If you guys are serious-close you might want to check out a local NAMI chapter and see if there is a support group for friends/relatives of patients which would be a good place for you to explore your own concerns.
Inpatient stuff is focused on getting people better but there is a lot of scheduled stuff and a lot of rules and regs. that can seem stifling or annoying. There's not a lot of opportunity sometimes for outside world communication so you might be able to, for example, start a small locked-down facebook group to give people updates and etc for your girlfriend's friends and people who might care. Just have an open mind and try to take it one day at a time.
posted by jessamyn at 6:57 PM on November 6, 2014 [3 favorites]
That's your issue to work out without your girlfriend, for the time being. The general model is to put the person who needs help in the center of the circle and then people close to them and then out from there. "comfort in, dump out" Ignore your perfect world, focus on your actual world and live within it.
The best things you can generally do are talk to other people about your concerns and feelings and show up for visiting hours with something tasty (or whatever your girlfriend's comfort items are that you are allowed to bring) and a willingness to listen, or just hang out, or whatever. It sounds like there's a lot of baggage in your girlfriend's life about mental health and you should work like hell to not add to that. Be a good listener. Educate yourself. If you guys are serious-close you might want to check out a local NAMI chapter and see if there is a support group for friends/relatives of patients which would be a good place for you to explore your own concerns.
Inpatient stuff is focused on getting people better but there is a lot of scheduled stuff and a lot of rules and regs. that can seem stifling or annoying. There's not a lot of opportunity sometimes for outside world communication so you might be able to, for example, start a small locked-down facebook group to give people updates and etc for your girlfriend's friends and people who might care. Just have an open mind and try to take it one day at a time.
posted by jessamyn at 6:57 PM on November 6, 2014 [3 favorites]
Does she have a medical power of attorney? And are you allowed to see her? Because it seems like you are her husband, but you guys aren't married, so you don't have the rights of a spouse or relative.
This stuff can be very scary, yes. And I agree, it's weird.
If I were you, I would contact the social worker at the hospital and see what you can do that way. What you need to know is when you can see her and how you can advocate for her health care. It can be very tricky, even for a spouse, let alone a boyfriend.
I disagree that it's your issue to work out with your girlfriend, it's frightening to have your partner go into a ward without anything put into place, and there should be more information. But that's not the law. Please get in touch with social services at the hospital and explain your situation before you listen to people here telling you that you have no rights. You are domestic partners, right? So you should be able to get some answers and help your girlfriend and get support for the both of you.
posted by Marie Mon Dieu at 8:29 PM on November 6, 2014
This stuff can be very scary, yes. And I agree, it's weird.
If I were you, I would contact the social worker at the hospital and see what you can do that way. What you need to know is when you can see her and how you can advocate for her health care. It can be very tricky, even for a spouse, let alone a boyfriend.
I disagree that it's your issue to work out with your girlfriend, it's frightening to have your partner go into a ward without anything put into place, and there should be more information. But that's not the law. Please get in touch with social services at the hospital and explain your situation before you listen to people here telling you that you have no rights. You are domestic partners, right? So you should be able to get some answers and help your girlfriend and get support for the both of you.
posted by Marie Mon Dieu at 8:29 PM on November 6, 2014
See if the hospital has or can refer you to a support group for care takers or people close to the patients. Basically, a support group for the support people.
You also need to realize that inpatient psychiatric care of today is generally a far cry from the horror stories of historical psych wards and popular media. The psychiatric hospital I was in actually had pretty good food (once I had enough of an appetite to notice).
Visit and talk with her on the phone when you can. Bring books or sudoku puzzles. I enjoyed coloring books. Ask the staff what clothing is and is not allowed and bring her something comforting. And warm fuzzy socks! I can not express how wonderful a gift those were.
And take care of yourself. If you don't, it will only get harder to support her.
posted by MuChao at 9:18 PM on November 6, 2014 [1 favorite]
You also need to realize that inpatient psychiatric care of today is generally a far cry from the horror stories of historical psych wards and popular media. The psychiatric hospital I was in actually had pretty good food (once I had enough of an appetite to notice).
Visit and talk with her on the phone when you can. Bring books or sudoku puzzles. I enjoyed coloring books. Ask the staff what clothing is and is not allowed and bring her something comforting. And warm fuzzy socks! I can not express how wonderful a gift those were.
And take care of yourself. If you don't, it will only get harder to support her.
posted by MuChao at 9:18 PM on November 6, 2014 [1 favorite]
Mod note: This is a followup from the asker.
Thanks for the responses so far. Just to be clear, I fully support my girlfriend's decision to get inpatient care, and I have zero judgement around issues of mental health. I see it as a medical issue and I feel incredibly fortunate that she's in a position to seek appropriate care without going into financial ruin.posted by cortex (staff) at 9:20 PM on November 6, 2014 [1 favorite]
When I said "I really don't like the idea of inpatient psychiatric care because it seems extreme" I said it in the same way I'd say, for example, "I really don't like the idea of chemotherapy because it seems extreme." But you'd better believe I'd support chemotherapy treatment for a cancer patient once they elected that treatment. Just because something is the right thing doesn't mean it's going to be easy, pleasant, or without side effects. That's all I meant by it. Also, I've told her unequivocally that I admire her for getting the medical treatment she needs.
I'll share some of what I've learned from going through this three times with a loved one
- it can be terrifying to be having hallucinations and thoughts of suicide. When you in a psych wrd, it can be reassuring to know that no matter what, they won't let you hurt yourself
- you can have a diagnosis of major depression with psychotic features (psychotic features = hallucinations) as well as quite a few other things that might include hallucinations. Hearing voices or seeing things does not necessarily mean schizophrenia. (you didn't say this but I've been surprised how many people assume it.
- the drugs to manage the hallucinations are probably the ones better known for treating schizophrenia and bipolar exactly because those are two diagnosis which are most likely to have hallucinations. also, all of these drugs impact the brain in complex ways - you really need a specialist to figure out the best combinations to try and even then they won't know which is right until they try. And many of them were originally used (and still) used for epilepsy so don't freak out if you google a medication and find out it is listed as an epilepsy med.
- the psych wards often have two sections - one for patients that are dangerous, acting out or more out of touch with reality and one for the rest. They will often keep a patient in the more secure side for 24 hours for observation and then move them over. The regular part of the ward is pretty much normal hospital except that you can't leave the general area
- depending on how bad her symptoms are, it may take a while for them to get her on the right meds and make sure they work. in our experience (and this is just three data points) it was about two week each time.
posted by metahawk at 12:10 AM on November 7, 2014
- it can be terrifying to be having hallucinations and thoughts of suicide. When you in a psych wrd, it can be reassuring to know that no matter what, they won't let you hurt yourself
- you can have a diagnosis of major depression with psychotic features (psychotic features = hallucinations) as well as quite a few other things that might include hallucinations. Hearing voices or seeing things does not necessarily mean schizophrenia. (you didn't say this but I've been surprised how many people assume it.
- the drugs to manage the hallucinations are probably the ones better known for treating schizophrenia and bipolar exactly because those are two diagnosis which are most likely to have hallucinations. also, all of these drugs impact the brain in complex ways - you really need a specialist to figure out the best combinations to try and even then they won't know which is right until they try. And many of them were originally used (and still) used for epilepsy so don't freak out if you google a medication and find out it is listed as an epilepsy med.
- the psych wards often have two sections - one for patients that are dangerous, acting out or more out of touch with reality and one for the rest. They will often keep a patient in the more secure side for 24 hours for observation and then move them over. The regular part of the ward is pretty much normal hospital except that you can't leave the general area
- depending on how bad her symptoms are, it may take a while for them to get her on the right meds and make sure they work. in our experience (and this is just three data points) it was about two week each time.
posted by metahawk at 12:10 AM on November 7, 2014
I spent the entirety of summer 2013 in inpatient psychiatric care, 3 weeks in a general psychiatric unit that was locked down (though some of us were allowed to go outside briefly at times for e.g. cigarettes), then four in an unlocked situation. Suicide attempt, major depressive disorder (and BPD, diagnosed while I was there), and transient hallucination/psychosis related to the depression. According to my psychiatrist there, psychosis secondary to depression usually resolves itself pretty quickly as the depression is medicated. Mine did.
Finding the right medication cocktail takes time, and as mentioned above there are many drugs which have beneficial off-label uses. Trazodone is an antidepressant used as a sleep aid, Seroquel (usually used for psychosis) is used for sleep and anxiety, etc etc.
Get in touch with the hospital's social worker. They'll be able to help you find out what is and isn't appropriate to bring/say/do, and will be able to put you in touch with resources that can help you.
You can definitely help her by making sure mundane outside-world details are taken care of: bills, cleaning the house, looking after pets, etc. The more worries you can remove, the better.
It's only rarely going to be appropriate for you to be present for sessions with her therapist. I understand how difficult that can be when it comes to advocacy, but that's just how therapy works.
My perfect world? She has her consultation with the doctor, he increases her dose of existing antidepressant or something, refers her to a therapist, sends her home the same day and she never has to deal with that type of experience again.
This is the first thing you need to adjust to. This is not your world. This is not about you. I totally get that you want to make it didn't happen, and trust me, so does she. When your mental health has deteriorated to the point where hospitalization is a good idea, it's virtually never going to be 'take these pills and everything will be fine.' It's a massively upsetting event. I've been hospitalized twice before in my life (72 hours and ~3 weeks) for the same thing--this is going to require a lot of aftercare when she is discharged. It may help your mindset to think of this as though she's been in a serious car accident; recuperation is going to take a long time.
Yes, the inpatient environment is artificial and locked down. There are good reasons for this. Safety, obviously; general psychiatric units will have a wide range of people suffering from a wide range of disorders that can be anything from generalized anxiety to full blown psychotic episodes. They do their best to segregate actively dangerous people into even-more-locked wards, but safety is a concern both individually (as in, self-harm) and collectively.
Second, part of the point of inpatient care is to completely disrupt your life, remove you from stressors, and allow you time to think and be calm. When you are in an extreme mental place, it takes extremes to help get out of it.
As for visiting:
1) Set up a visiting schedule with her, and stick to it come hell or high water. Whatever timing and frequency she wants. Ask her if there's anyone she wants to see, and get them to come.
2) Depending on what they will allow into the unit, bring food. Hospital food is horrendous at the best of times; psychiatric hospital food is nigh inedible. Last summer, a friend of mine made that part of it bearable by providing me with some good salt (Maldon), a tiny little spritz bottle of balsamic vinegar, and chili flakes. Also odd bits of candy, occasional baked goods, bottles (plastic) and/or cans of pop or juice, that sort of thing. Think about her comfort foods and see which of those you can bring. Ask the staff--some places have rules like 'only stuff in sealed packages' because of the concern about drugs coming into the ward. There may be a communal fridge for patients; ask. If you bring anything needing refrigeration (my friend also brought me freezies; it was summer, and they were popular) be sure to label with her name.
3) If she gets outside passes, go for walks. There was a nice little courtyard with a fountain near where I was, and it was comforting to just go and dip my feet in the water.
4) Let her set the tone and content of all conversations.
5) Books, if she's a reader, are a godsend. There was a small bookshelf where I was, but most of the books were terrible (I left a few behind). Playing cards, if they don't already have them, are great too--even if they do have them, buy a couple decks she can leave behind anyway; we used to make terrible jokes about not playing with a full deck (seriously). Jigsaw puzzles are nice, too; quiet and contemplative. Crosswords, etc.
6) Be aware that she's going to be somewhat in turmoil, especially if they're fiddling with medication to find the right combination for her.
7) If you can bring movies, those are good too. Again, ask the care team; they may have guidelines about what is and isn't allowed.
8) Photographs are nice to have, too. Again, ask her what she wants.
9) A pillow or blanket from home. Also, if they're wearing street clothes on the ward, comfortable things to wear. There's a tendency/temptation to sort of go fuckitall and wear sweats; it's a difficult balance to achieve but something that's a step above "Hi I'm a mental patient" can help with self-care and self-image.
10) Again, subject to ward rules, personal grooming items, moisturizer especially (hospital air seems very dry to me always). Her favourite soap/shower gel would be nice.
11) Basically, ask her what she wants and needs, and provide those things. Be clear if there's stuff you can't do; being in hospital necessarily means you're in a pretty fragile state, so it's important to manage expectations and not disappoint if possible.
If it's reasonable for you to do so, the staff on the ward will basically never turn down fresh coffees or other treats for themselves. They have a very hard and sometimes dangerous job. I'm not saying bribe them or whatever, just saying that the happier the staff is, the better able they are to care for everyone on the ward. Brightening their day will brighten hers, too.
Last but not least: take care of yourself. Having a loved one in this kind of distress can make you feel impotent and alone. Ensure you are practicing good self-care--sleeping enough, eating properly, that sort of thing. Find someone close who you can talk to about your feelings. Again, the social worker at the hospital should be able to help you find support groups. You can't be strong for her if you're not looking after yourself, is what I'm saying.
Email's in profile if you need it.
posted by feckless fecal fear mongering at 8:13 AM on November 7, 2014 [8 favorites]
Finding the right medication cocktail takes time, and as mentioned above there are many drugs which have beneficial off-label uses. Trazodone is an antidepressant used as a sleep aid, Seroquel (usually used for psychosis) is used for sleep and anxiety, etc etc.
Get in touch with the hospital's social worker. They'll be able to help you find out what is and isn't appropriate to bring/say/do, and will be able to put you in touch with resources that can help you.
You can definitely help her by making sure mundane outside-world details are taken care of: bills, cleaning the house, looking after pets, etc. The more worries you can remove, the better.
It's only rarely going to be appropriate for you to be present for sessions with her therapist. I understand how difficult that can be when it comes to advocacy, but that's just how therapy works.
My perfect world? She has her consultation with the doctor, he increases her dose of existing antidepressant or something, refers her to a therapist, sends her home the same day and she never has to deal with that type of experience again.
This is the first thing you need to adjust to. This is not your world. This is not about you. I totally get that you want to make it didn't happen, and trust me, so does she. When your mental health has deteriorated to the point where hospitalization is a good idea, it's virtually never going to be 'take these pills and everything will be fine.' It's a massively upsetting event. I've been hospitalized twice before in my life (72 hours and ~3 weeks) for the same thing--this is going to require a lot of aftercare when she is discharged. It may help your mindset to think of this as though she's been in a serious car accident; recuperation is going to take a long time.
Yes, the inpatient environment is artificial and locked down. There are good reasons for this. Safety, obviously; general psychiatric units will have a wide range of people suffering from a wide range of disorders that can be anything from generalized anxiety to full blown psychotic episodes. They do their best to segregate actively dangerous people into even-more-locked wards, but safety is a concern both individually (as in, self-harm) and collectively.
Second, part of the point of inpatient care is to completely disrupt your life, remove you from stressors, and allow you time to think and be calm. When you are in an extreme mental place, it takes extremes to help get out of it.
As for visiting:
1) Set up a visiting schedule with her, and stick to it come hell or high water. Whatever timing and frequency she wants. Ask her if there's anyone she wants to see, and get them to come.
2) Depending on what they will allow into the unit, bring food. Hospital food is horrendous at the best of times; psychiatric hospital food is nigh inedible. Last summer, a friend of mine made that part of it bearable by providing me with some good salt (Maldon), a tiny little spritz bottle of balsamic vinegar, and chili flakes. Also odd bits of candy, occasional baked goods, bottles (plastic) and/or cans of pop or juice, that sort of thing. Think about her comfort foods and see which of those you can bring. Ask the staff--some places have rules like 'only stuff in sealed packages' because of the concern about drugs coming into the ward. There may be a communal fridge for patients; ask. If you bring anything needing refrigeration (my friend also brought me freezies; it was summer, and they were popular) be sure to label with her name.
3) If she gets outside passes, go for walks. There was a nice little courtyard with a fountain near where I was, and it was comforting to just go and dip my feet in the water.
4) Let her set the tone and content of all conversations.
5) Books, if she's a reader, are a godsend. There was a small bookshelf where I was, but most of the books were terrible (I left a few behind). Playing cards, if they don't already have them, are great too--even if they do have them, buy a couple decks she can leave behind anyway; we used to make terrible jokes about not playing with a full deck (seriously). Jigsaw puzzles are nice, too; quiet and contemplative. Crosswords, etc.
6) Be aware that she's going to be somewhat in turmoil, especially if they're fiddling with medication to find the right combination for her.
7) If you can bring movies, those are good too. Again, ask the care team; they may have guidelines about what is and isn't allowed.
8) Photographs are nice to have, too. Again, ask her what she wants.
9) A pillow or blanket from home. Also, if they're wearing street clothes on the ward, comfortable things to wear. There's a tendency/temptation to sort of go fuckitall and wear sweats; it's a difficult balance to achieve but something that's a step above "Hi I'm a mental patient" can help with self-care and self-image.
10) Again, subject to ward rules, personal grooming items, moisturizer especially (hospital air seems very dry to me always). Her favourite soap/shower gel would be nice.
11) Basically, ask her what she wants and needs, and provide those things. Be clear if there's stuff you can't do; being in hospital necessarily means you're in a pretty fragile state, so it's important to manage expectations and not disappoint if possible.
If it's reasonable for you to do so, the staff on the ward will basically never turn down fresh coffees or other treats for themselves. They have a very hard and sometimes dangerous job. I'm not saying bribe them or whatever, just saying that the happier the staff is, the better able they are to care for everyone on the ward. Brightening their day will brighten hers, too.
Last but not least: take care of yourself. Having a loved one in this kind of distress can make you feel impotent and alone. Ensure you are practicing good self-care--sleeping enough, eating properly, that sort of thing. Find someone close who you can talk to about your feelings. Again, the social worker at the hospital should be able to help you find support groups. You can't be strong for her if you're not looking after yourself, is what I'm saying.
Email's in profile if you need it.
posted by feckless fecal fear mongering at 8:13 AM on November 7, 2014 [8 favorites]
I recently did two stints inpatient for suicidal ideation and auditory hallucinations. For me, the structured routine was a big part of relieving some of the stress I was under. Hallucinations are scary. It's taken the better part of 3 months to get mine under control.
As far as the some kind of med like for schizophrenia, you have to understand the current generation of meds are used for many kinds of things. I take an old one because I can't tolerate the weight gain of the current ones. It's not a thing of shame. It's no different than being on one of the meds for diabetes and then having to change to insulin.
If you have any specific questions you can memail me.
posted by kathrynm at 4:31 PM on November 7, 2014 [1 favorite]
As far as the some kind of med like for schizophrenia, you have to understand the current generation of meds are used for many kinds of things. I take an old one because I can't tolerate the weight gain of the current ones. It's not a thing of shame. It's no different than being on one of the meds for diabetes and then having to change to insulin.
If you have any specific questions you can memail me.
posted by kathrynm at 4:31 PM on November 7, 2014 [1 favorite]
I'm a nurse at a psychiatric inpatient facility. This isn't medical advice, this is just my view.
What are the best things I can do to help here?
Everyone in this situation is on your girlfriend's side. The staff are trained professionals in this exact type of situation. They more than likely can pick up on the subtleties you're worried your girlfriend can't express. The locked down environment isn't just for her benefit; she's part of a group now, all receiving treatment. There are hard, bright-line boundaries that have to be set so that everyone can stay safe.
Your girlfriend is there to get back to her normal and competent self. This is not a long-term situation. This is a safe place, somewhere she can start new medications and potential side effects can be monitored and corrected.
Hang in there, and offer her what she needs, that you can do for her.
posted by RainyJay at 12:44 AM on November 9, 2014 [2 favorites]
What are the best things I can do to help here?
Everyone in this situation is on your girlfriend's side. The staff are trained professionals in this exact type of situation. They more than likely can pick up on the subtleties you're worried your girlfriend can't express. The locked down environment isn't just for her benefit; she's part of a group now, all receiving treatment. There are hard, bright-line boundaries that have to be set so that everyone can stay safe.
Your girlfriend is there to get back to her normal and competent self. This is not a long-term situation. This is a safe place, somewhere she can start new medications and potential side effects can be monitored and corrected.
Hang in there, and offer her what she needs, that you can do for her.
posted by RainyJay at 12:44 AM on November 9, 2014 [2 favorites]
This thread is closed to new comments.
You can't wish it away or pretend it didn't happen. If she was having ideation strong enough to choose 24/7 treatment, normal and competent are not what was happening. Delusions are serious and might affect her for the rest of her life if this turns out to be a neurological or ongoing psychological disease. If you're going to judge her for being anything other than temporarily ill, your support sounds a whole lot more like manipulation.
Maybe you just need to step back and let the qualified professionals treat her. If you can be of assistance in a practical manner - taking care of things at her home, making any phone calls or email she asks you to, and offering her whatever nonjudgemental emotional support you can, but I think maybe you just need to not discuss her condition with her unless she wants to.
posted by Lyn Never at 3:47 PM on November 6, 2014 [13 favorites]