**This week’s blog posts are dedicated to advocating for effective mental health treatment and educating patients, family, and friends in all areas of inpatient psychiatric care. The perspectives shared here are not that of a mental health professional, but rather someone with lived experience. Information shared may not align with every circumstance or viewpoint of readers, but is meant to offer guidance in an area that is often confusing and holds little resources.**

Whether you are the person needing acute psychiatric care, a loved one directly involved in the process of getting someone to help they need, or an indirect bystander, the first day in inpatient care can be a mind-numbing experience. Tensions and emotions run high, those directly involved are at a point exhaustion, and what’s important may rush past you before you know it. The most important factor to keep in mind through all of this is this is the necessary step to wellness and as is with all temporary things, it will get better.

#1 – Getting to the hospital – There are many paths this part takes. Some may take an ambulance to an emergency room from their home following a 911 call. Others may check in at an ER after a sleepless night in crisis. Walk-ins to standalone psychiatric facilities is yet another way. Based on what is to follow, I believe the best method in arriving for intake, if available, is to contact your established psychiatrist or psychologist to see if they have connections to nearby facilities so they can contact the facility directly and act in their capacity as a healthcare provider to secure a bed. This will make the rest of the steps much shorter.

#2 – Packing for your stay – This is a step that is not always available, but when it is, can alleviate a lot of stress and confusion along the way. Most psychiatric facilities hold similar restrictions on what items can be brought by a patient to be used during their stay. You will definitely notice what makes it to your room is much less than you arrived with, but all restricted items are safely inventoried and held by the hospital to be given to you at a later time (1-2 days after intake) or returned when you are discharged. Items to leave at home are tennis shoes with shoestrings, electronics, jewelry, any clothes with drawstrings, and spiral-bound notebooks. Personal hygiene items should be packed together (fit into a gallon ziplock bag as a rule of thumb – remember to pack chapstick!). You will not be given these items, but may be able to access them later in your stay. The hospital will provide the basic necessities. Generally 2-3 outfits are permitted. The hospital is very cold always, so pack layers – warm socks, house slippers, long sleeve tees, sweats, and a comfortable sweatshirt. Comfort items I suggest taking are a pillowcase from your bed at home and a small throw blanket. Know that you will likely not be allowed these items, but if you request these from your doctor the first time you meet, they can literally write an order/prescription for you to have these items and it makes a difference in an otherwise unfamiliar place. The last and most important item to take is a single piece of paper with names and phone numbers of anyone you could possibly want to contact, including therapists and doctors. Keep this on your person as you won’t know when the rest of your belongings will be processed and provided to you.

#3 – Hurry up and wait – While it may seem like a life-threatening crisis would instill a great sense of urgency to admit a patient, the reality is there is a huge shortage of beds available. In fact, the sad truth is in this system, the best way to be admitted quicker and to the best quality of care is having solid private health insurance. Be prepared to sit in an uncomfortable room guarded by police officers for 12 hours or more with very little communication or care. Don’t expect to be admitted to the hospital you arrive in, as they may have no beds available but are not allowed to let you leave once checked in. They will transport you via ambulance or police car to the nearest facility with the first opening that accepts your insurance. Ask if a family member or friend can sit and wait with you, though it will not always be allowed in the secure setting. If you do end up being admitted where you originally check in, you will speak to an administrative person to give insurance information, meet with a doctor/nurse practioner to assess whether you need inpatient care, and possibly be visited by someone to take urine and blood samples.

#4 – Parting ways with friends/family – This may happen at any stage from the moment you walk in to when you walk onto the psychiatric floor. Advocate for yourself up to the point of being admitted to have your loved one with you. If you feel comfortable, they can even be by your side as you talk with a professional, have labwork done, and wait in a secure area. Know that the moment you allow separation to occur, it is very hard to regain being together and it is also the moment any information to that support person ceases. In most cases, they will no longer have the ability to know where you are (even if you are transported to another facility) or any knowledge of visiting procedures, ways to contact you, or what care is being provided to you. In most facilities, contact with the outside world is restricted for 24-48 hours. This is where the written list of contact information is integral. Usually one phone call once the patient arrives on the floor is allowed. This person should be ready to take a call from an unknown number. Let them know the name of the facility, patient contact phone number, any required secret access codes in order for people to contact the patient (usually they will ask for you to choose a four-digit code that must be given over the phone before any acknowledgement the patient is in fact there), and information on times allowed for incoming calls. This person should then be responsible for searching online to find visiting hours and procedures and communicate to the rest of the family and close friends all of this information.

#5 – The first 24 hours – During the first 24 hours of being on the psych floor, it can be the most challenging and confusing time for everyone involved. The person on the inside will experience what feels like their dignity being stripped away as all of life’s comforts are immediately removed. The people on the outside can find themselves worrying more than before their loved one made it into the facility due to no contact and lack of information, as they have just handed the reigns over to strangers in the hospital. The expectations of emergency care quickly are realized to be very different from reality. In most cases, the first thing a person will do is be offered a meal or snack to eat while the nursing staff complete paperwork. Given the circumstances of how long their wait was and if they have been up all night long in the ER, the patient may be shown to their room and given a sedative to sleep or rest. At some point in the first 24 hours, you will be seen by the doctor who will be meeting with you daily. This is a very short visit typically (sometimes lasting only a few minutes). Be sure to ask as many questions as you can, request your comfort items (you won’t have a chance to do this again for another 24 hours), and give a good history including any medications you are currently on or have had success with in the past. Remember to give yourself time to breathe, let your body rest, and relax in knowing you took the hardest step in getting help. Ask when the next group is meeting and if you can attend. Generally, they will not disturb you in the first day while resting to attend every group, but the sooner you participate in the process, the sooner you will feel better.