**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.**

One of the thoroughly confusing things the first times I was hospitalized in inpatient psychiatric care was who all the people who were not patients were and what their role was. For a while, I didn’t even know they had different jobs and would get frustrated when I would ask one person a question and they told me to ask someone else. It left me feeling as though I was an afterthought and they didn’t want to deal with my problems. At first, I just stopped asking questions. Eventually, a kind mental health tech explained the entire structure to me one late night and my stays were so much smoother from then on out. So here they are, in no particular order:

#1 – Mental health technicians – Sometimes just referred to as a “tech,” these are sometimes the hardest working, least appreciated employees in a hospital. You will find techs spending all of their time in the general population area, amongst the patients. They handle all practical requests such as needing an extra blanket, wanting to get into your room (if rooms are locked during the day), requests to take a shower or sharpen colored pencils, really anything you can think of. Their actual job is maintaining a safe environment, observing behavior, taking vitals in the morning and when needed, doing safety checks for individuals on suicide watch, and providing physical security if the need arises. They likely will be asking you questions throughout the day regarding your mood, level of depression/anxiety/suicidal thoughts, and charting the information for the nurses and doctors. They will lead group sessions with or without curriculum to teach coping skills, address concerns, or bring up morale.

#2 – Nurses – Nurses are usually stationed behind a desk or even a wall with a glass window that opens and shuts. They are there to monitor physiological and medical wellbeing and are rarely the right resource for general questions. They administer medications several times through the day to the appropriate individuals and chart any medical concerns. Occasionally, personal hygiene items will be held behind the nurses desk for check-out, but first ask the tech what the procedure is for receiving this at morning/evening/shower times. If you are not feeling well, aren’t sleeping well, feeling extremely anxious, or have any need for medical attention, you can go directly to the nurses’ station. They are not usually up for chatting or keeping company as their jobs are demanding and require every minute of their shift to complete.

#3 – Psychiatrists – The doctors will come in once a day, usually at different times. Some will come the same time every day (always the morning, or even late at night). You will be assigned to one doctor you will see throughout your stay and your first visit will be with them within 24 hours from arriving on the floor. From then, you will see them once every weekday and once over the weekend. They typically will meet with you for a brief time (can range from 2 minutes – 15 minutes). Any requests for items that have been restricted from you should go through your doctor. For example, if you brought a personal item like a stuffed animal that didn’t make it to your room, you can ask if they can write an order for you to have that comfort item. Be sure you know before-hand what questions you need to ask because you won’t have contact with your doctor for another 24 hours. Their role is to assess your mental state, prescribe medication and treatments, and determine readiness for discharge.

#4 – Therapists – There are several types of therapists you may encounter in a psychiatric hospital. The most common will be licensed counselors or psychologists. They, like the doctors, will come in throughout the week. Typically, they will only come once or twice a week. You may have a chance to meet one-on-one with a therapist for a 30-60 minute session, but these do not happen often. For the most part, therapists will come in to lead group therapy sessions or even educational groups about mental health. Another common type of therapist you could see, depending on the facility, is an occupational/recreational therapist. They will come to lead low-impact exercise group sessions or recreational game sessions. You can ask the nurses’ station if you would like to speak with a therapist to get put on their schedule.

#5 – Social Workers – This person is the main connection to the outside world for the patient. Along with updating authorized family members about inpatient treatment, they work to find resources for the patient after discharge from the hospital. Closer to the discharge date, they will meet more often with you to go over your plan for care in the days and weeks following discharge. Typically, protocol is to have an appointment scheduled with an outside psychiatrist within 48 hours of discharge and have first therapy (whether individual or outpatient group therapy) appointment scheduled to happen within 1-4 weeks of discharge. For people who are in need of other resources, such as housing, occupational, food assistance, healthcare, etc, the social worker will handle this as well.

It definitely takes a village to bring mental health to someone in crisis. In my experience, even the other patients can play a process in your journey to wellness. The key thing to keep in mind is these people are really here for you only for this season. You very likely will never encounter the patients, the techs, the nurses, the doctors, or the therapists again in your lifetime. Some will make the biggest impact on your life and you will never know their last name. Be sure to show your gratitude while you can and thank them for what they do.

**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.

TW: suicidal ideation

Today was a hard day. A person I care about required immediate intensive care for suicidal plans. I have mulled over and over what to speak on in this post. The last time this happened for them, I was inspired in the moment to begin a YouTube channel. I think I even created it and made the first video post introducing myself. But that was all I did. From my lengthy experience with severe mental health treatment, I have carried a deep passion and vision for changing the mental healthcare system. I don’t know how or when my impact in all of this will come to fruition, if ever. What I can do now is advocate and speak up in the midst of the way things work in today’s world.

Let me preface everything I am about to say with this statement: The most qualified and equipped people to provide guidance in effective change to the mental health system are ones who have needed the mental health system. Yes, even more than the doctors and therapists trained in all specialties and definitely more than politicians and policy makers. With that in mind, know that everything I have learned about how the system could work better came during a time when I was mentally ill, but was developed and fine-tuned when I was mentally well.

The best advice I can give to anyone facing a severe mental illness and their family and friends is to remember what you are fighting for and what you are fighting against. So often, when the disease takes over control, it seems as though we are fighting every tactic and justification and pleading of the person we love to get them help. Know this is far from the truth. You are fighting against the disease and fighting for the person locked inside. It is just at this very moment, your loved one has lost the ability to fight the disease any longer. We all have the same enemy, the disease. Too often, the desire to maintain control looks like the mentally ill person fighting against any help from family and like the family is fighting against the mentally ill person to strip away their freedom. If we do not step back and instead give in to this idea, this is when the disease thrives.

So what can we do? When emotions are at an all-time high, and words and actions are internalized by everyone involved? When a life is on the line? When we feel powerless? We can join together and turn our anger and frustration away from each other and place it all on the despicable monster, the disease. Take the power away from the disease! Tell all its secrets, lies, and manipulations! Expose it for what it is and deny it any more power. For a time, this has to be carried by the family and friends. Speak truth in love, maintain as much dignity and control as possible for the person suffering, and know when action must be taken. And trust in the body’s natural response to threat to life. Just as when we naturally fight to breathe when drowning, the body will fight for that last ditch step to save their life.

I realize much of what I said is conceptual and not practical. This practical guidance is what I hope to achieve into the future, and plan to shift gears this week. I will dedicate my blog posts to a beginner’s guide to inpatient psychiatric hospitalization this week. Please feel free to share with anyone you know could use this now or in the future.