maybe I could let somebody else call the shots.
January 8, 2021 7:34 PM Subscribe
due to the events of this week in the us and their effects on my mental health, I am considering checking myself into an institution with inpatient emergency mental health services. I currently live in the us, I have existing issues with depression and anxiety and this week is too much for me to cope with. I am not suicidal, just terrified/overwhelmed/not taking care of myself and the pets well. What should I know going into this? What should I look for in picking an institution? Anything is helpful. Thank you.
I have a roommate who can look after the pets but we're not close and they are also emotionally maxed out. everybody I know is either similarly maxed out, or think that the situation is a good thing.
I have a roommate who can look after the pets but we're not close and they are also emotionally maxed out. everybody I know is either similarly maxed out, or think that the situation is a good thing.
If you have not been inpatient before, I would caution you that in my experience, hospitals vary wildly. I've been involuntarily hospitalized twice and voluntarily twice.
All inpatient psychiatric care made me feel much, much worse immediately. The best I ever got from a stay was "did not hurt myself further physically."
There might not be room for anyone who is not emergency room level suicidal/homicidal, and often I was the 'least sick' person there, meaning that everyone else was at that level of intense management being necessary. It was not peaceful or therapeutic at any point.
If the hospital is used to involuntary patients, you may not be allowed to leave of your own volition even if you entered voluntarily-- this happened to me at my first voluntary hospitalization.
(If the hospital takes only voluntary patients, they are likely to be set up for a more appropriate degree of client engagement in your situation. That was my experience at my last voluntary inpatient stay. )
---
A potential source of information is to contact your local NAMI chapter and/or other local mental health client advocacy groups and ask which hospital people have appreciated or gained from staying with. Mental health recuperation and appreciation or enhancement of health are actually not outcomes that the inpatient system is set up to deliver. Frankly, right now, I'm not sure I'd go in under any circumstances.
You may wish to look into mental health peer respites in your area or state. Those are likely to be a much calmer, thoughtful, client-centered recovery home-like experience.
posted by saveyoursanity at 9:06 PM on January 8, 2021 [33 favorites]
All inpatient psychiatric care made me feel much, much worse immediately. The best I ever got from a stay was "did not hurt myself further physically."
There might not be room for anyone who is not emergency room level suicidal/homicidal, and often I was the 'least sick' person there, meaning that everyone else was at that level of intense management being necessary. It was not peaceful or therapeutic at any point.
If the hospital is used to involuntary patients, you may not be allowed to leave of your own volition even if you entered voluntarily-- this happened to me at my first voluntary hospitalization.
(If the hospital takes only voluntary patients, they are likely to be set up for a more appropriate degree of client engagement in your situation. That was my experience at my last voluntary inpatient stay. )
---
A potential source of information is to contact your local NAMI chapter and/or other local mental health client advocacy groups and ask which hospital people have appreciated or gained from staying with. Mental health recuperation and appreciation or enhancement of health are actually not outcomes that the inpatient system is set up to deliver. Frankly, right now, I'm not sure I'd go in under any circumstances.
You may wish to look into mental health peer respites in your area or state. Those are likely to be a much calmer, thoughtful, client-centered recovery home-like experience.
posted by saveyoursanity at 9:06 PM on January 8, 2021 [33 favorites]
Do you have your own team (therapist and psychiatrist) to guide you in this decision?
Have you talked them with about the possibility of an Intensive Outpatient Program (IOP). These are a step down from the full locked hospital ward - program during day (or part day) and you go home to your own place at night. For the full day program, you would still need to take a medical leave of absence from work (which sounds like it would be a good idea) but you would be with people who were stable - still struggling with symptoms but in touch with reality, not suicidal and able to do a minimal level of self-care.
My second hand experience via a family member with several voluntary psych admissions is that the hospital stay was mostly focused on keeping things safe until they got the meds right. The IOP gave her a place to go to figure things a bit (and do some arts and crafts) until she was ready to go back to just twice a week therapy and monthly psych visits.
posted by metahawk at 9:43 PM on January 8, 2021 [5 favorites]
Have you talked them with about the possibility of an Intensive Outpatient Program (IOP). These are a step down from the full locked hospital ward - program during day (or part day) and you go home to your own place at night. For the full day program, you would still need to take a medical leave of absence from work (which sounds like it would be a good idea) but you would be with people who were stable - still struggling with symptoms but in touch with reality, not suicidal and able to do a minimal level of self-care.
My second hand experience via a family member with several voluntary psych admissions is that the hospital stay was mostly focused on keeping things safe until they got the meds right. The IOP gave her a place to go to figure things a bit (and do some arts and crafts) until she was ready to go back to just twice a week therapy and monthly psych visits.
posted by metahawk at 9:43 PM on January 8, 2021 [5 favorites]
I haven't been treated in-patient, but have experienced rapid escalations in level of care.
If you're currently on meds, they may radically alter your medication regimen. I'd assume that, even though you're saying you're not suicidal, they may ask to take your shoelaces away, etc.
In my most intensive, most effective treatment setting, there is paperwork. Tons and tons of paperwork, filled out at regular intervals, checking and re-checking symptoms. It was annoying at first and I can't always see its purpose exactly, but I've come to recognize it as a sign of a sophisticated, well-designed program because it connects to many other aspects of the treatment.
For me, every counseling session ends with “homework”, a small task or exercise or two to do before the next session, mostly self-determined now that I've got a good relationship with my therapist, responding to some aspect of what we're working on with my particular issues.
One big thing - after you're back in calmer waters, don't feel hesitant to take some initiative in directing your own care. In my own case, the organization I'm working with required me to switch from my long-time psychiatrist to one who worked in the same office as my new therapist; but really, it's been an enormous pain in the ass, and now that all of that paperwork shows I'm doing much better by every measure I'm about to deliver an ultimatum in my next counseling session that I want to switch back to my original psychiatrist, my way or the highway, because it's what's best for my health.
Good luck, and please believe in yourself.
posted by Sockpuppet Liberation Front at 11:39 PM on January 8, 2021
If you're currently on meds, they may radically alter your medication regimen. I'd assume that, even though you're saying you're not suicidal, they may ask to take your shoelaces away, etc.
In my most intensive, most effective treatment setting, there is paperwork. Tons and tons of paperwork, filled out at regular intervals, checking and re-checking symptoms. It was annoying at first and I can't always see its purpose exactly, but I've come to recognize it as a sign of a sophisticated, well-designed program because it connects to many other aspects of the treatment.
For me, every counseling session ends with “homework”, a small task or exercise or two to do before the next session, mostly self-determined now that I've got a good relationship with my therapist, responding to some aspect of what we're working on with my particular issues.
One big thing - after you're back in calmer waters, don't feel hesitant to take some initiative in directing your own care. In my own case, the organization I'm working with required me to switch from my long-time psychiatrist to one who worked in the same office as my new therapist; but really, it's been an enormous pain in the ass, and now that all of that paperwork shows I'm doing much better by every measure I'm about to deliver an ultimatum in my next counseling session that I want to switch back to my original psychiatrist, my way or the highway, because it's what's best for my health.
Good luck, and please believe in yourself.
posted by Sockpuppet Liberation Front at 11:39 PM on January 8, 2021
I've unfortunately been hospitalized in psych wards many, many times, both voluntarily and involuntarily. My problems were quite different from yours (mine were mania and psychosis) but I think I'm still entitled to advise you that checking yourself into a psych ward should be your absolute last resort. What saveyoursanity writes rings true with my experience. They vary considerably but in general psych wards are not peaceful places, you can (legally) lose your liberty to leave after you've checked in and they can give you medications you really don't want to be taking, against your will. Also, being a patient in a psych ward is very bad to have in your life history. No matter how enlightened you and your social circle may feel you are about 'mental health'. It sets a bad precedent, warping how you and others perceive and envision yourself, which adversely affects life chances. At the risk of some simplification, I'd say that if psych wards serve a legitimate purpose, it's as places to tranquilize and sedate those who are so psychotic or otherwise out of control that they are plainly, in the classic phrase, a danger to themselves or others. This doesn't sound like you.
Also, I have to imagine that a psych ward, where physical confrontation between staff and patients or between patients is truly not uncommon and personal space is not in the best of times always very ample, is just a terrible place to be during a mounting pandemic. I shudder to think how psych nurses go about trying to maintain social distancing.
I'm sorry I don't have positive advice about what to do, where to go, in your situation. NAMI might be a source of leads, as saveyoursanity suggests -- although they are as an organization imo much too invested in the medical-model of psychiatric problems, and thus might steer you wrong. One thought: If you have any religious affiliations -- or even have any friends who have religious affiliations who could network for you -- some religious groups might through their experience of pastoral care know of resources to help you more appropriate than a mental hospital. People do, for instance, go on retreats, stay in monasteries whether Buddhist or Christian, for a time, or other peaceful, structured places. There are some such places you don't have to be an adherent to participate/attend. A week of gentle guided mindfulness meditation might do wonders.
Again, I'm sorry not to have more definite advice. Please allow yourself the patience to choose what to do with some wisdom!
posted by bertran at 3:21 AM on January 9, 2021 [26 favorites]
Also, I have to imagine that a psych ward, where physical confrontation between staff and patients or between patients is truly not uncommon and personal space is not in the best of times always very ample, is just a terrible place to be during a mounting pandemic. I shudder to think how psych nurses go about trying to maintain social distancing.
I'm sorry I don't have positive advice about what to do, where to go, in your situation. NAMI might be a source of leads, as saveyoursanity suggests -- although they are as an organization imo much too invested in the medical-model of psychiatric problems, and thus might steer you wrong. One thought: If you have any religious affiliations -- or even have any friends who have religious affiliations who could network for you -- some religious groups might through their experience of pastoral care know of resources to help you more appropriate than a mental hospital. People do, for instance, go on retreats, stay in monasteries whether Buddhist or Christian, for a time, or other peaceful, structured places. There are some such places you don't have to be an adherent to participate/attend. A week of gentle guided mindfulness meditation might do wonders.
Again, I'm sorry not to have more definite advice. Please allow yourself the patience to choose what to do with some wisdom!
posted by bertran at 3:21 AM on January 9, 2021 [26 favorites]
I have been a voluntary inpatient in a locked ward several times, in my case for suicidal ideation. A few things you may not know (all based on my experience, so possibly not true in all cases):
I had to sign papers saying that if I wanted to leave, if they thought I should stay, I would give them three days to get a court order to commit me.
If it's a locked ward, they will go through all of your belongings and search you to make sure you don't have anything you can hurt yourself with. This is true even if you aren't suicidal, as your room isn't locked and other people will have access to your stuff. (A number of patients pretty openly stole stuff from the hospital when they left - robes, towels, sheets, even a phone - this was before everyone had a cell phone.)
All night long, nurses came into every room every thirty minutes and looked around with flashlights to make sure everyone was OK. This makes it hard to sleep.
You will be expected to participate in activities all day long: group therapy, art therapy, music therapy. You may or may not find this helpful, but sitting in your room or the common area instead will probably not be an option.
Agree that other patients can be disturbing to be around (also, see stealing above). I spent a lot of time talking to a guy who turned out to be a pedophile, and another man told us they wouldn't let him leave because they thought he'd murder his wife.
Building on bertran's suggestion, I have also stayed in an Anglican monastery, which actually was a restful, peaceful experience. They asked us to attend short services twice a day, but otherwise, our time was our own. I am religious, but I went with a friend who was not, and she also very much enjoyed it. Unfortunately, they are not currently accepting guests due to COVID.
Are you in touch with a mental health provider who knows this is an option for you? I am not sure how easy it is to decide you want to get this kind of help if you're not wealthy or a celebrity.
I have also participated in a day program. Again, this is activities all day long.
And I hope things get better for you. This is an extraordinarily tough time for everyone, and mental health issues add an extra layer of awful.
posted by FencingGal at 5:59 AM on January 9, 2021 [10 favorites]
I had to sign papers saying that if I wanted to leave, if they thought I should stay, I would give them three days to get a court order to commit me.
If it's a locked ward, they will go through all of your belongings and search you to make sure you don't have anything you can hurt yourself with. This is true even if you aren't suicidal, as your room isn't locked and other people will have access to your stuff. (A number of patients pretty openly stole stuff from the hospital when they left - robes, towels, sheets, even a phone - this was before everyone had a cell phone.)
All night long, nurses came into every room every thirty minutes and looked around with flashlights to make sure everyone was OK. This makes it hard to sleep.
You will be expected to participate in activities all day long: group therapy, art therapy, music therapy. You may or may not find this helpful, but sitting in your room or the common area instead will probably not be an option.
Agree that other patients can be disturbing to be around (also, see stealing above). I spent a lot of time talking to a guy who turned out to be a pedophile, and another man told us they wouldn't let him leave because they thought he'd murder his wife.
Building on bertran's suggestion, I have also stayed in an Anglican monastery, which actually was a restful, peaceful experience. They asked us to attend short services twice a day, but otherwise, our time was our own. I am religious, but I went with a friend who was not, and she also very much enjoyed it. Unfortunately, they are not currently accepting guests due to COVID.
Are you in touch with a mental health provider who knows this is an option for you? I am not sure how easy it is to decide you want to get this kind of help if you're not wealthy or a celebrity.
I have also participated in a day program. Again, this is activities all day long.
And I hope things get better for you. This is an extraordinarily tough time for everyone, and mental health issues add an extra layer of awful.
posted by FencingGal at 5:59 AM on January 9, 2021 [10 favorites]
A relative of mine works at a psych ward that is substantially understaffed because of covid, and has had to consolidate patients into a smaller space and figure out procedures on the fly to try to keep folks safe. I would definitely look at other options first.
The suggestion to temporarily foster pets sounds like a good one! I know in our area there are waiting lists for pet adoption, so this might be easier than usual.
posted by john hadron collider at 6:59 AM on January 9, 2021
The suggestion to temporarily foster pets sounds like a good one! I know in our area there are waiting lists for pet adoption, so this might be easier than usual.
posted by john hadron collider at 6:59 AM on January 9, 2021
I feel for you, OP. I looked into this myself several years ago at a low point and was warned away by many (including here on MeFi) because inpatient mental health stays are not what they look like in books and movies and are actually not much of a “break” from your life in the way you are hoping for. I personally had conflated the idea of inpatient mental health with some sort of rehab (?) in my deep yearning for someone to just ::waves hands:: take care of me for a bit so I didn’t have to do it myself.
I think you might consider putting out a call for personal respite care: someone you can go to who will literally take care of you every day for a week, prep your meals, make you attend daily Zoom therapy, do daily yoga with you, whatever your daily needs are. It doesn’t really have to be someone professional as long as they are caring, and it can be a friend in a non-local place if you are willing to get yourself there. In Covid times I might consider paying someone who is otherwise out of work to do this, as it’s possible it wouldn’t be any more unsafe than an inpatient ward and might be cheaper in the end anyway depending on your insurance.
posted by juniperesque at 7:12 AM on January 9, 2021 [10 favorites]
I think you might consider putting out a call for personal respite care: someone you can go to who will literally take care of you every day for a week, prep your meals, make you attend daily Zoom therapy, do daily yoga with you, whatever your daily needs are. It doesn’t really have to be someone professional as long as they are caring, and it can be a friend in a non-local place if you are willing to get yourself there. In Covid times I might consider paying someone who is otherwise out of work to do this, as it’s possible it wouldn’t be any more unsafe than an inpatient ward and might be cheaper in the end anyway depending on your insurance.
posted by juniperesque at 7:12 AM on January 9, 2021 [10 favorites]
You don’t mention it but if you have any level of trauma associated with Your diagnosis, but if you do, emergency inpatient may not be the best thing for your mental health. It is a very controlled, and observed setting, so if you suffer from any sort of hyper-vigilance, this can be exacerbated pretty drastically. They’re designed to keep you alive until you stabilize. If you’re not a danger to yourself, I would avoid this.
I had/have a fairly severe PTSD diagnosis and will be avoiding emergency inpatient for the rest of my life...programs vary, but knowing what I know now about my mental health and how trauma interacts with it, inpatient is just not designed to help, it’s designed to keep you alive and safe. If you’re not safe, hang up metafilter and head on down ASAP.
However, with some stupid insurance rules and wait times to see certain mental health providers, being in an emergency inpatient setting can bump you up to the front of the line for certain other services (like an intensive outpatient program). I’m not going to say that you should lie to get in, but if that’s your only option, it’s your only option. If you need immediate access to like a PMHNP or psychiatrist and don’t have one, this can be an effective way to engage in those services quickly.
Feel free to me mail me if you need to.
posted by furnace.heart at 7:55 AM on January 9, 2021 [1 favorite]
I had/have a fairly severe PTSD diagnosis and will be avoiding emergency inpatient for the rest of my life...programs vary, but knowing what I know now about my mental health and how trauma interacts with it, inpatient is just not designed to help, it’s designed to keep you alive and safe. If you’re not safe, hang up metafilter and head on down ASAP.
However, with some stupid insurance rules and wait times to see certain mental health providers, being in an emergency inpatient setting can bump you up to the front of the line for certain other services (like an intensive outpatient program). I’m not going to say that you should lie to get in, but if that’s your only option, it’s your only option. If you need immediate access to like a PMHNP or psychiatrist and don’t have one, this can be an effective way to engage in those services quickly.
Feel free to me mail me if you need to.
posted by furnace.heart at 7:55 AM on January 9, 2021 [1 favorite]
OP, if after reading all of the above, you aren't interested in checking yourself in to whatever inpatient option you have at this time, would you be interested in seeking ways to stay home, manage your mental health at home, and tips to smooth that experience/process?
posted by erattacorrige at 8:14 AM on January 9, 2021 [3 favorites]
posted by erattacorrige at 8:14 AM on January 9, 2021 [3 favorites]
the absolute best thing about going inpatient is that you are immediately separated from all of the situational shit that is causing problems - so you get some breathing room. and a chance to figure out how you are going to handle things going forward!
posted by megan_magnolia at 11:06 AM on January 9, 2021
posted by megan_magnolia at 11:06 AM on January 9, 2021
I have been inpatient a few times, about a decade ago (one voluntary, one technically voluntary but under threat of involuntary commitment so...). I was hospitalized at a very well respected psychiatric hospital, in a unit that was specifically for short term hospitalizations for people with mental health issues but no psychotic patients, nothing that felt threatening.
Even with all that going for it, based on my personal experience, I can't imagine every voluntarily going inpatient again. Some of this depends on personality - I know a few people who felt inpatient was a more positive experience.
For me, it was necessary, because at the time, I was a raging alcoholic at serious risk of hurting myself. (I'm now thankfully sober for nearly a decade). I think going inpatient for me was very much the right step to take at the time, and probably saved my life, but that was mainly because I don't think I could have gotten sober outside of an inpatient setting.
Inpatient treatment can be really important - for someone dealing with uncontrolled mania or psychosis, substance abuse, suicide risk. But it's not exactly therapeutic, at least in my experience. They had some sort of therapy groups, but in my case, a lot of the people i interacted with who worked on the inpatient ward were recent college grads with know advanced mental health training.
Residential treatment is "inpatient" treatment but generally a more house like setting, with actual therapy. However, in my experience, it is often private pay only or very difficult to get insurance to cover. And insanely expensive. But it's still something to look into - there are some that you can use insurance for, depending on your insurance.
I've done a couple intensive outpatient and partial hospital (day) programs, and I had very positive experiences there. If you don't feel like you are at a safety risk, I would defiintely recommend looking into those. A lot of them may be virtual, but I actually did a virtual partial hospital program in June, and it still worked well from my perspective.
If you can afford it, and if you deem it safe from a COVID perspective, maybe even staying in a hotel for a few days could help? You could order room service, you wouldn't have to do any housework or cooking.
If I found myself in need of something like this and I could afford it, I honestly think hotel + day program is what I would try to arrange. You get a break from your real life and real therapy, without the added stress of an inpatient stay.
With all that being said, if you feel like an inpatient stay is the right step, or if you're somewhere where your mental health treatment options are limited or hard to access, and definitely if you feel like you might be a risk to yourself, then I'm certainly not trying to talk you out of an inpatient stay. I think it's just important to have realistic expectations of what you're likely to get. It will give you a break from your day to day life, but in return, most of your control is taken away from you, which can be disorienting and upsetting. But still, those inpatient stays probably saved my life.
Of course, YMMV, IANAD/IANYD/IANAmental health clinician. No matter what you choose to do, I hope you find the help you need. Good luck!
posted by litera scripta manet at 1:43 PM on January 9, 2021 [4 favorites]
Even with all that going for it, based on my personal experience, I can't imagine every voluntarily going inpatient again. Some of this depends on personality - I know a few people who felt inpatient was a more positive experience.
For me, it was necessary, because at the time, I was a raging alcoholic at serious risk of hurting myself. (I'm now thankfully sober for nearly a decade). I think going inpatient for me was very much the right step to take at the time, and probably saved my life, but that was mainly because I don't think I could have gotten sober outside of an inpatient setting.
Inpatient treatment can be really important - for someone dealing with uncontrolled mania or psychosis, substance abuse, suicide risk. But it's not exactly therapeutic, at least in my experience. They had some sort of therapy groups, but in my case, a lot of the people i interacted with who worked on the inpatient ward were recent college grads with know advanced mental health training.
Residential treatment is "inpatient" treatment but generally a more house like setting, with actual therapy. However, in my experience, it is often private pay only or very difficult to get insurance to cover. And insanely expensive. But it's still something to look into - there are some that you can use insurance for, depending on your insurance.
I've done a couple intensive outpatient and partial hospital (day) programs, and I had very positive experiences there. If you don't feel like you are at a safety risk, I would defiintely recommend looking into those. A lot of them may be virtual, but I actually did a virtual partial hospital program in June, and it still worked well from my perspective.
If you can afford it, and if you deem it safe from a COVID perspective, maybe even staying in a hotel for a few days could help? You could order room service, you wouldn't have to do any housework or cooking.
If I found myself in need of something like this and I could afford it, I honestly think hotel + day program is what I would try to arrange. You get a break from your real life and real therapy, without the added stress of an inpatient stay.
With all that being said, if you feel like an inpatient stay is the right step, or if you're somewhere where your mental health treatment options are limited or hard to access, and definitely if you feel like you might be a risk to yourself, then I'm certainly not trying to talk you out of an inpatient stay. I think it's just important to have realistic expectations of what you're likely to get. It will give you a break from your day to day life, but in return, most of your control is taken away from you, which can be disorienting and upsetting. But still, those inpatient stays probably saved my life.
Of course, YMMV, IANAD/IANYD/IANAmental health clinician. No matter what you choose to do, I hope you find the help you need. Good luck!
posted by litera scripta manet at 1:43 PM on January 9, 2021 [4 favorites]
I know you -- the OP -- can't give us an update without breaking your anonymity, but I want you to know I've been worrying about how you are doing and that my thoughts are with you. I remember how scary it can be to be in psychological difficulties and not know where to turn. I hope you are managing okay and are able to take steps to buttress your mental well-being.
posted by bertran at 11:44 PM on January 9, 2021 [5 favorites]
posted by bertran at 11:44 PM on January 9, 2021 [5 favorites]
Call 211. They will tell you what is available. Everyone there has gained much experience this past year.
You'll probably do a zoom intake the next day and talk over the options and do a more specific intake with someone else after you pick. It's easy.
Best
posted by Mr. Yuck at 1:56 AM on January 10, 2021
You'll probably do a zoom intake the next day and talk over the options and do a more specific intake with someone else after you pick. It's easy.
Best
posted by Mr. Yuck at 1:56 AM on January 10, 2021
I am thinking about you too, OP. I wish I had answers for you but I don't-- just offering you support from this internet stranger.
posted by fairlynearlyready at 1:42 PM on January 10, 2021 [2 favorites]
posted by fairlynearlyready at 1:42 PM on January 10, 2021 [2 favorites]
This thread is closed to new comments.
posted by phunniemee at 7:53 PM on January 8, 2021 [10 favorites]