**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.**

From the moment you walk away after helping a loved one to be admitted to inpatient psychiatric care, you can easily feel powerless and unable to provide any additional support. However, there are a few avenues of care that can still be maintained from the outside. Significant others and caregivers may feel a large range of emotions stepping away, from relief in knowing their loved one is finally in a safe place and no longer requires constant attention from them to helplessness in not knowing how to fill their time now they have been removed from the process of caring for that individual. Here are some steps to fill this gap:

#1 – Do your research – It is most likely you will receive very little information from the hospital, especially if you must part ways from your loved one before the admitting process takes place. In many cases, an ER will even transport your loved one to a completely different facility based on availability of beds without your knowledge. This can be a terrifying ordeal when trying to contact this person later, as confidentiality laws prohibit hospitals from confirming or denying the presence of a psychiatric patient. This is why it is suggested to demand for a significant other, family member, or friend to remain with the person in crisis throughout the process until they are walking onto the psych floor of a facility. The only other method of obtaining this information is by the patient initiating contact through phone once admitted (don’t forget to have full phone numbers written down on a paper the patient keeps with them in their pocket – they will not have access to their contact list on their phone once admitted).

Once you know the facility in which your loved one will be staying, search online for the facility website. Make notes of visiting hours and procedures, patient phone numbers and times open for incoming calls, and any other nurse or information phone numbers. Some websites will have general descriptions of the facility’s programs, daily schedule, or family resources. Typically, you will need to wait for the patient to make the first contact as communication with family can be restricted for the initial period of time they are hospitalized. In some cases, the admitting nurse will allow the patient to make one phone call when they arrive on the floor and that call needs to be mostly about obtaining the necessary information for future communication. Ask general questions of your loved one, such as: when can I call you next? what number do I call? is there a security code you set up that I need to give the nurses when I call? when can I first visit? what time is visitation? All of these questions could involve your loved one asking the nurse or tech close by for information.

#2 – Maintain contact with nurses and doctors – Families should designate the best person to be a main contact with nurses and doctors regarding the care of the patient. Don’t have too many cooks in the kitchen. This person should be someone who is assertive and proactive in obtaining information and persistent in contacting the nurseline daily at a minimum. Establish this relationship with the nurses early, calling within 1-2 hours of initial contact with the patient. It is a relationship that must be built and may not be fruitful in the first few attempts. Once the nurses, doctors, and social workers realize you are determined to stay involved in your loved ones care and feel respected by you, a cooperative effort in getting the patient well can start. The first contact can sound like this, “Hello! I am calling about my daughter XXXX XXXXX, her security code is XXXX. I wanted to speak to a nurse or her assigned social worker about how she is doing so far, and see if there is anything I can do to assist in her receiving the care she needs while she is there.”

Follow up the next morning, saying “Good morning! I am just checking in on XXXX XXXXX. I called yesterday and spoke to XXXXX. How did XXXX sleep last night? Will she be seeing a doctor today? I would also like to plan to visit during visiting hours today. Is that permitted at this time?” The more you become familiar with the staff working, the better the information you will receive and the more effective your help once your loved one is discharged from the hospital will be.

#3 Make regular phone calls to your loved one – Psychiatric hospitals usually have common areas for patients to spend time between time in their rooms resting, meals, and group therapy sessions, and have phones to make and receive calls from family and friends. It is better to start small, with only closest family and friends making contact and sometimes waiting for the patient to reach out to others. For this reason, it is best practice to let concerned friends and extended family know you will give your loved one their phone number for them to call when they are ready to talk. Ask your loved one when the best time for you to call them (does dinner happen from 5-6 when phones are open but they are in a different room? have they been going to bed at 8 even though phones are open until 10pm?). Set up a time you plan to call at least once a day so they will be in the area to take the call, and make sure your loved one knows they can call you as much as they want outside of that time. Set a reminder on your phone to call at the planned time and always make an attempt every day. Save the phone number you receive your first call from the community phones as a contact in your phone so you recognize it as them calling.

You may struggle at knowing what to talk about the first few times you get on the phone with your loved one. Avoid asking how they are feeling or if they feel better unless they have demonstrated to you they want to talk about these things. They are likely overwhelmed with a lot of techs, nurses, doctors, and therapists constantly asking these questions, and this should be a time they have a break from that and have contact with the outside world. Be ready with a few lighthearted stories about what has gone on in your day and your world. Ask about general, concrete things such as “Is your bed comfortable? Do you have a roommate? What did you have for lunch today?” Be ready to be the one who initiates the end of the conversation as your loved one will probably feel uncomfortable telling you they are done talking. Have a good excuse (“Well, I have got to get dinner started. Call me later tonight if you want to. Otherwise I will call again at this time tomorrow.”) Expect your first conversations to be very brief and generally for calls to last less than 10 minutes. It may not seem like anything to you looking in from the outside, but it will make a difference to the one on the inside to receive communication and love from the outside. It lets them know they are not forgotten and gives hope their life will be there waiting for you.

#4 Visiting the patient in person – This can be one of the most challenging activities in the entire experience for both the family and friends and the person in the hospital. While one hour at first seems like not enough time every day or twice a week (depending on the facility’s structure), you will find yourself searching for something to talk about ten minutes after arriving. Be prepared to see your loved one in a state different than you normally see them. They might be very nervous and even feel a sense of shame being seen in the hospital and can change the way they behave or communicate. Avoid making big sweeping statements such as “You look great!” or “You look like a trainwreck! Have you been sleeping at all?” Speak the truth of your observations but soften it. “It looks like you might be feeling better. Does it feel like that to you?” or “How did you sleep last night? Is it hard to sleep in a different place?”

Try to bring something to do together to fill the time with something other than talking. I have found one of the best things to have for visitation is a deck of cards. Bring it and set it on the table, maybe start shuffling the cards, but don’t have expectations of playing. Conversation may flow and your loved one may have a lot to talk about, but if the conversation lulls and awkward silences come in, suggest you play a game. Suggest a favorite game you have played in the past, or teach a simple new game. A somewhat competitive game can lighten the mood and even at times be a great release of positive emotions between the two of you. Be careful not to disturb the other visiting guests and patients. Even playing a game of solitaire together can help connect you. If you feel the visit has had quality connection only 30 minutes in, don’t be afraid to ask your loved one if they are ready to go back or if they want you to stay the entire time. Sometimes a short visit can serve a better purpose than sitting in silence to take up the entire time. Before leaving, ask if there is anything you can bring them next time they may have forgotten at home (slippers, more socks/underwear, chapstick, a new notebook to write in).

#5 Set up support for yourself after phone calls and visits – Remember to take care of yourself in the midst of all of this. The hospitalization may be happening to your loved one, but you cannot support that person very well if you do not have an outlet for emotion. Give yourself time to feel and reach out to someone outside your ring (see yesterday’s blog post) shortly after times you communicate with your loved one. It can be very beneficial to set up a few therapy sessions for the time your loved one is hospitalized to process the experience as it is happening.

I will close by saying the most important day to visit, in my opinion, is Sunday. For most facilities, groups, individual therapy sessions, doctor visits, and treatments occur Monday through Friday. Saturday seems to be a good day to rest from all the activity, but Sunday can feel very isolating and alone. Whenever I was hospitalized, I would tend to reflect a lot on Sundays about family and where I was and a full gamut of other things that generally would leave me melancholy. Suddenly, not receiving a visit can leave you feeling abandoned or trapped without outside contact. Remember, the self esteem of the individual in the hospital likely is at an all time low, so reaching out and asking for what they need is rare. Take the initiative to call daily, visit whenever available, and keep up to date on how treatment is going from the staff.