What Happens When my Child/Teen is Admitted into Acute Psychiatric Care? (Part 2 of 3)

Admitting your child to acute psychiatric hospitalization can be traumatic for both of you. Part of the difficulty is due to the fact that there is so much mystery and unknown surrounding the experience. My son has had at least 10 hospitalizations in his life to date, two of my other children have had one hospitalization, and we have experience with multiple facilities. I wanted to share some of our experiences and answer some of the questions I'm most asked.

In VA (where we currently live) every hospitalization will come out of the emergency room after a medical exam where the doctor decides hospitalization is necessary. As I mentioned in my previous post about what to expect during an ER visit, I shared that this process can be painfully long as you wait for a bed to open up in a (hopefully) nearby facility. My oldest son has been hospitalized in the facility closest to us many times, but my other two children both had to go to different cities as they were too young for that particular hospital. Be prepared to have your child in a facility that is not local to you.

The Admission Process:

Usually your loved one will be transferred to the psychiatric hospital or behavioral health facility in an ambulance. I have always followed behind to get them settled. Once you arrive, you will go through a lot of paperwork and your child will be asked again if they have thoughts of hurting themselves or others, and if so, if they have created a plan. By this point in the process both of us are  always tired, and these questions and the stack of paperwork can be wearying. Many times the admission process happens in the middle of the night due to the long hours already spent in the ER. It's easy to feel overwhelmed, doubt yourself when you realize they are now calm (which is very common at this point in the process) and you just want to sleep and/or eat.

Your child will have to remove any article of clothing that could be a potential threat- such as shoelaces, belts, hoodie draw strings, sometimes even body piercings. I have learned to take along a bag if I suspect hospitalization will be the result of our ER visit- and include sweatpants, pajamas, a book or two, cotton shirts, socks, underwear. Every facility is different, but most will allow some personal items including a blanket or pillow, sketch books, stuffed animal, clothing, even family photos. I have learned having things from home can be very comforting to him while he's there. The nurse will take the items from you to ensure you haven't unknowingly (or, sadly, some parents knowingly) brought anything restricted by the facility. If we don't arrive with a bag, I bring items back the next day.

Inside the Ward:

You may be allowed to go into the ward/unit (these words can be used interchangeably) to see where they will be staying and sleeping, or, you may not. Don't be alarmed if you aren't given the opportunity to see the rooms- it is often for the safety and privacy of the other patients. Every room we've experienced share similar traits: sparse, often just a bed (or two) and night stand and desk. The bathroom mirrors are unbreakable and often there is very little wall color or decor. The first time I saw this, my son wasn't yet four and it was a shock to me, but as I've become a veteran to the process, I understand the practicality and safety, and can appreciate the intentional design of a non-stimulating environment. Often our children are so overwhelmed by their emotions, hormones, misfiring neurons, that the lack of clutter and visual stimuli can be very calming, even as it looks bleak to us.
There is usually a 'day room' with TV, nurses' desk, tables, chairs, and couches. Patients can gather to talk, play games, do schoolwork, make simple crafts, or watch TV. There may be a cafeteria. We are incredibly spoiled in this area as the hospital Samuel has stayed most in has one where I can visit and buy lunch or dinner for myself that is actually quite tasty. It helps both of us to have that time together and I'm grateful for it.

Your child will be in what's called a locked unit.  It was jarring to me to have all of the doors of the halls and units locked, and initially it can feel a bit like prison, especially when you hear the slam of the door and the lock engage behind you while you walk away from your child. Remind yourself that this is for everyone's safety. Most units are co-ed and often they will have a same sex roommate. They will be assigned a case worker and during their stay they will be evaluated by the doctor, given meds by a nurse, (if needed) and sometimes they'll spend time with a caseworker whose job is to create a skeleton treatment plan for post-discharge.

Leaving your child to go home can be very difficult. You may feel all sorts of emotions; from relief to sadness, grief, shame, guilt, anger. Don't try to analyze your emotions at that moment; let them be what they are. Your child will likely have many emotions too- and it can make it exponentially difficult to leave if they are angry at you for admitting them, or if they are scared or anxious.
Try to keep the knowledge that they are safe in the front of your thoughts. Both of you need to try and get some rest.

You will be given a specific pin number to use when you call to speak to your loved one. This is again, for privacy. You'll be told about visiting hours and any additional information about the facility to allow you to visit, communicate, or check in on your child. You may be called in for a visit with the case worker during their stay, or you may have emails and phone calls. The lack of communication can feel very strange when you don't realize this is the norm. The real work will come outside of the facility. This time is to reset, ensure safety, and work to get outside resource and support in place.

What I Wish I'd Known:

• If you don't have a diagnosis already, you aren't likely to get one- even if they write down information/symptoms/and potential diagnoses on the discharge paperwork. 
• If you do have a diagnosis before the hospitalization, you may see something completely different on the paperwork. Don't put much stock in this. There will be no testing, no critical observation and no deep dive into their struggles during their stay in effort to diagnose.
• Acute hospitalization is used for stabilization and safety. Often there isn't much more. Your child may be offered some therapy- both alone and with a group; however, many times these sessions are not required. It's possible your child could stay and not once have any level of therapy.

I was devastated with my son's first hospitalization and having to leave him behind, but I was hoping for answers. At the time of admission, we'd had a couple of hellish years without any explanation and I was desperate to kick start whatever meds, therapy, or help that might save us. Imagine my shock and disappointment when he was discharged and the nurse told me they hadn't seen any of the behaviors I'd reported. This is also a huge possibility. You may have left behind a raging, emotional, anxious, insomniac and return only to be told they've been calm, sleeping well and respectful. The structure of the ward can be very relieving to kids who have been stuck in an emotional meltdown, and while it's hard not to be validated by the staff's direct observation of the symptoms, know that this time away has been a rest for their brain.

There is so much more I could write, but this is incredibly long as it is. We'll come back to this topic again and cover more, but for now, this helps to give a good generalized look at what to expect. Information is power and can help both of you to combat anxiety should you find yourself in this situation. That's my goal: help demystify the process and give you more control.

What Happens When My Child/Teen Goes to the ER for Psychiatric Care? (Post 1 of 3)

I am part of a private Facebook group for parents of children and teens who have bipolar or other mood disorders. Many caregivers post a frantic cry for support when their child goes into psychiatric hospitalization. I've also received emails, texts, and private messages from friends and friends of friends asking what to expect or looking for reassurance. I've decided to create a series of three blog posts covering some of the most asked questions and offering information to help educate and dispel some of the mystery.
The three posts will cover what to expect when your child/teen is in the emergency room, what acute/short term hospitalization looks like, and our experience with long term/residential treatment. Please share these posts with anyone who can use them!

What To Expect When Your Child or Teen Winds Up in the Emergency Room For Psychiatric Care:

You've found yourself at the ER with your child seeking psychiatric intervention. There are many ways this can happen: Your child is out of control, or has what the system calls "suicidal ideation", or is self harming, seems delusional; the list is endless. They may arrive by ambulance, in a police car, or under police escort, or simply in your personal vehicle. We have been to the ER many times and have arrived in my car, in my car with police escort, and in an ambulance.

Here is what you need to know:

First- don't forget to breathe. I'm very serious. I know that it's scary, and unknown, and heartbreaking to find yourself in this position, but you have to dig deep and stay calm. Your child needs you more than ever and you will need to be able to rationally answer questions, give accurate history, and most likely, spend a lot of time with your child just waiting. Staying calm might be the most difficult thing you do during this experience, especially if you came to the ER due to any violence or destructive behavior directed at you or your family. Anger is the natural response to that, and yet, for the well being of all of you, you must find a way to momentarily compartmentalize those emotions and be a calm presence for your child.

Be prepared to wait. And then wait some more. This can be an incredibly frustrating part of the process. Many hospitals have specific rooms for mental health patients, and will only utilize those rooms unless it is a life or death situation. With the continually growing mental health crisis in our country, this often means that when you arrive, the rooms are already occupied- leaving you and your child in the waiting room- many times for hours on end. Our longest stay was 27 hours from start to finish- but part of that was waiting on a bed to open up in an acute psychiatric hospital (more on that in the next post).

When you arrive and check in, you will register, give proof of insurance if you have it, then you will wait for triage. After triage (where a nurse asks you why you've come and checks your child's vitals) you will probably be sent  back to the waiting room. Your child may be called again for a blood draw, and if so, once again, you most likely will be sent back to the waiting room. Once called into a room you may notice it's different than other rooms in the ER. It may even be in an area that is closed off from the other rooms. Many rooms used for mental health patients have been prepped- often stripped of any extra instruments or objects that you'd see in other rooms to protect patients from potentially hurting themselves or others.

You can expect to see a nurse, a social worker or mental health worker, hospital registrar, and doctor at a minimum. Each time, your child will be asked if they are having thoughts of harming themselves, and if so, if there is a plan. This is tedious. It feels traumatic to have to answer that over and over, or watch your child have to repeatedly answer those questions. Just remind yourself it's part of protocol. There may be police presence. At our local hospital, there is an officer who sits outside of the mental health rooms. This is again, preventative and for protection, but I'll admit, it can make the process feel further stigmatized and removed from 'normal'.
Your child will be under a strict one on one instruction- meaning, they won't be allowed to be left alone. You will have to stay with them the entire time, and they will have to ask to use the restroom. If your child doesn't want you with them (which happens, and you will have to find a way to stand up under the weight of that pain somehow knowing they aren't well in that moment) then they will have a nurse with them constantly. If they are overly agitated or anxious, your child may be offered something to help calm them.

Prepare yourself to know there won't be a diagnosis in the ER. There will be no 'problem solved' or magic bullet. It can feel anticlimactic after the chaos that sent you there. It can be exhausting in every way, and you will likely experience a myriad of emotions. If you know some of this ahead of time, it can help you adjust your expectations so you don't wind up feeling discouraged.

Generally the goal is to create a plan going forward in order to discharge your child. This may be for your child to return home with instructions to follow up with a psychiatrist. Or, it may be that the next step is acute hospitalization at a mental health facility. In the state of VA where I live, you are no longer allowed to self-admit. You must have a medical clearance first- meaning you and your child may know that he/she wants and needs hospitalization, but you must still go through the red tape of the ER visit to justify it. If hospitalization is the next step, you will be waiting again. Hospitals are packed full and many times you are stuck waiting for a bed to open up at a facility. Often those facilities aren't local to you. The younger your child, the fewer options there are, which can mean a longer wait and possibly a facility that is a longer distance from your home. In our state if you are stuck in the ER waiting for more than 24 hours for a bed to become available, they usually admit your child to the hospital while you wait- putting you in limbo until there is space.
While this is frustrating, and shines a spotlight on the scale of psychiatric care needs, it is normal. Discouraging, yes. But sadly, normal. Most of the time a trip to the ER is a marathon, not a sprint. Try to relax if you can. I've told my son jokes, showed him vines on my phone, watched him try to sleep, played music, and calmed him when his anxiety from the wait overtook him.

The good stuff: Remember your child is in a safe place during the visit. That may be the only consolation for you in the moment, but don't discount it. Breathe it in deeply. If this is your first trip to the ER for this level of care, you are now in a good position to continue to advocate for your child in other arenas; school, counseling, testing, possibly ABA therapy or OT (for children with Autism or sensory issues), the option of getting an advocate or case worker; you have now reached a level of need that makes it obvious how desperately you need a support team. Take advantage of this reality and ask as many questions about available resources as you need to before you are discharged.

Finally: I know you feel utterly alone. You may feel as though you've failed somehow. This is a normal reaction, but it's not true. Many of us have been through this with our children- you don't know only because we aren't posting pics of them in the hospital bed on Facebook and Instagram the way parents of physically ill children often do. We're hidden in plain sight- but trust me; you are not alone. Also, you have no obligation to share information with anyone. You don't owe anyone an explanation, and you don't have to try and defend your choice (or, forced action if others were involved). As hard as it may be, find a way to stay calm and set boundaries. Privacy and space is rightfully yours and you are permitted to take all the time you need to decide what (if anything) you desire to share with anyone other than those intimately involved. You are going to get through this- and you, sweet parent or caregiver- are an amazing and loving person who is doing an incredibly difficult and compassionate thing. Much love!

The Only Way Out is Through

This is another excerpt from my manuscript- it took place when Samuel was in residential treatment a couple of years ago.
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We sat side by side on the small overstuffed love seat. There were no windows in her office, and the lighting came from table lamps instead of the harsh fluorescents overhead. Bookshelves lined the wall opposite of us, her desk against another, and her worn arm chair was pulled close to the love seat. Donna’s demeanor was comforting and accepting, and her obvious love for Samuel helped bring a measure of peace to my ragged soul. I’d anticipated hard therapy sessions and had welcomed them. Healing of any kind rarely happens without some level of pain, and I was desperate to feel the pain in the immediate if it would bring about wholeness and restoration for our future. She has a way of asking questions that dig deep yet honors the person and their experiences. We’d only had a handful of sessions before this one, several phone conversations and a dozen or so emails- yet she understood our family dynamic and I finally felt truly seen. She leaned back into a comfortable position in her chair and asked gently and pointedly if I knew how my frustration had sometimes come through to Samuel as resentment. 

I felt him shift slightly in his seat, and the familiar lump formed in my throat. I nodded slightly as tears pooled in my eyes. I had used that ugly word before in safe places- relationships with friends who love me and love my Samuel – and I’d felt them leave my lips in a release coated with both shame and relief. I had never heard another mother say those words about her child; yet I couldn’t deny the painfully real awareness that resentment had grown in me. Before I nodded, my mind flashed briefly with the thought of denying it; meaning to protect his heart from more hurt and rejection. What mother wants her child to know she has resented him?! But I was there to face the truth of the state of our relationship, not to hide under idealized daydreams of what I’d hoped would be. I wanted to qualify the term- to let him know it wasn’t him as a person I resented. I wanted to stand up and face him to make my case that the resentment was against the illness, the ‘disorder’, the life we’d been given with his father that had wounded all of us. I was frantic on the inside to reassure him that the poisonous resentment wasn’t aimed at his heart, or personality, or humanity. But I was silenced. In that brief moment of panic, I also knew; to qualify my emotions would diminish his. To beg him to try and understand my reasoning for the hurt he’d felt leaking from my own brokenness would invalidate his experience. I let the painful silence hover. I sat under the weight of my own failure and pain. Terrified to look at him and see hurt shadow his beautiful eyes. Shame worked its slimy tentacles into my headspace and the broken mother in me longed to give it power, sensing the acceptance of shame might somehow atone for the ugliness of the hurt I’d laid on the broad shoulders of my son.
He didn’t speak. I held my breath waiting for anger, or withdrawal; preparing him to say with bitterness “I knew it.” But no words came. His body relaxed. The moment was enormous and vast and awful and simple and unassuming and anticlimactic all at once. He’d already known. He’d felt it through the years when my frustration consumed me and I’d lashed back at him with anger and disdain. He’d known. He’d felt it when my body would turn away from his as he told me excitedly about his newest obsession and I’d cringe with the fear that another unattained object of desire would unleash his violent meltdowns.
As I sat next to him in silence, the few moments felt like an eternity. I’d sensed his physical rigidity soften as I’d nodded in shame, and my overactive intuition told me he was grateful for the admission. My willingness to own the awful, unwanted feeling had given him back some dignity. Confidence. Reassurance that he hadn’t imagined things. So I sat; hands clasped tightly in my lap, and facing forward while I waited. I willed my tears to stop in order to honor him in the moment. A few tears managed to slide down my flushed cheeks, but I didn’t dare move to brush them away and break the energy in the room. I wouldn’t allow myself to hijack his chance to absorb the work we’d done in our session by giving way to the desperate sobs that threatened to break from my chest. I stared at the bookcase watching the titles of books about mental illness swirl together into a colorful puddle of mocking self- help. I heard him inhale deeply, and he stretched his legs in front of him preparing to stand up for the end of our session. Still, I sat. Filled with crashing emotions and thoughts; anger at the illness that had done so much damage to our relationship, anger at myself for not being stronger and more understanding, grief over the reality of driving home without him yet again, and desperate to pull him to me and dissolve every hurt he’d ever had with the thud of my heart against his chest. But our session was over. It was time for him to head back to the unit, and for me to drive home. I turned to him and he hugged me. “I love you, Mom.” The familiar voice and sentence reminded me that hurting relationships don’t equate to dead relationships, and I knew he knew I loved him back. “I love you too buddy.” I whispered into his neck before pulling back to smooth my clothes, wipe my face and follow the therapist out of the maze of longs halls and locked doors. As we walked in silence, I understood that the damage from my resentment had already been done. In that moment, the best gift I could offer to him was admitting I’d hurt him; and in that admission, in that dredging up of shameful feelings and brokenness revealed, I could feel it. We were starting to move towards freedom.  

Descent

I've been working on my manuscript that I plan to self publish and also hope to one day publish traditionally- I thought I'd share a chunk today as it's fresh on my mind and heart and I thought you might appreciate reading a bit of it.
So... here you go!

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I wasn't allowed to stay with him. My not-quite-yet four year old son would be in the hospital without me for several days. Parents weren't allowed to stay outside of assigned visiting hours, and I would have to leave him in the care of strangers. We were four hours from home and my temporary bed would be at the Ronald McDonald House located a few blocks away. Heavy with the knowledge that I would be leaving him there, those two blocks felt more like a million miles. I had no way of absorbing that pain in the moment. I had to be strong for him, and reassure him that all of this was perfectly normal. He takes his cues from me, and I drew on every ounce of strength within me to present myself assured and calm.

After we'd arrived on the ward and been given the tour, a nurse led us back to the main area and I knew it was time for me to leave. He'd lagged a short distance behind us as we'd woven our way through the halls, his ruffled blond hair bouncing atop his head like a buoy in the ocean. Eyes wide with curiosity, he seemed to believe we were on a grand adventure. I avoided looking down at him to keep myself from feeling anything. I was numb; the overwhelming reality of my young son entering psychiatric care had washed over my senses like a sticky film. I'd nodded in recognition when she had shown me the room where patients gathered to watch movies and play board games, and as she led us through the rest of the wing, I'd scanned the halls for signs of comfort and reassurance that my oldest boy, the one who had thrust me into motherhood with gusto, would be safe and well cared for.

We circled back around to stop in front of the charge nurse's desk. I looked down into his bright questioning blue eyes to tell him I loved him and would be back in the morning. My smile felt borrowed from someone else and I knew he could sense my hesitation as he stared back at me. Breaking our unspoken communication, I bent down to pull him close, nuzzling my face into his neck and reassuring him he was okay and I loved him desperately. He was silent and stoic, tilting his had like a beloved family dog trying to comprehend words flung into the air. As I straightened, I was suffocated with feelings of failure laced with the thin thread of hope that maybe I had rescued him. Maybe this time real help would come. This time we'd find the elusive freedom. My heart split wide open under the pressing weight of guilt and shame. Tears threatened to slide down my face, and I refused to allow them access in that moment. Lies of inadequacy hovered around me like thick smoke, and the slash in my heart gave space for them to take up residency. Walking towards the heavy grey metal doors meant turning away from him. Turning from him felt horrifically symbolic and I rebelled against the wretched feeling. I felt as though all of the air had been sucked out of the room and the carpet seemed to stretch in front of me for miles. The rock in my chest grew heavier with each step I took; creating space between us that felt both visceral and emotional. I swallowed and tried focusing on the colorful childish paintings hanging on the walls. Reassuring myself we'd come to a place of help and treatment became my mantra, threading itself through my brain to keep thoughts of panic and desperation from landing. When I finally put my hands on the door, the steely cool of its surface bore testimony to the atmosphere; cold and sterile. Turning my face back to him, I was relieved and crushed to find him still watching me. His features were so baby-like, innocent and fresh. he understood I was leaving for the night, but thankfully, he didn't have the maturity to grasp the gravity of this dramatic initiation into psychiatric care at such a tender age. He stood rooted in the same spot, next to a faceless nurse wearing cheery, bright scrubs. He was so small. So young. How was I to leave him here without me to protect him from unseen dangers, from others who might not understand his behavior and words?! I was pierced again with the default statement I'd adopted as a mother at some point on my journey: I was a failure. I could see him struggling to fight back tears, and fresh grief washed over me knowing I couldn't run back to wrap my arms around him with protection, reassurance, and comfort. There was no comfort for us to be found in that moment, only the stark reality of reaching for support for our future to buffet me from complete wasting.

The Post That Meets My #2 Goal for This Week

I've worked on a manuscript for my book on and off for years. In 2017, I won a contest with a few of the chapters from my book and was given a trip to a writing conference and workshop complete with a writing coach. My coach was a best selling author and I learned so much from her- but her recommendations on how to change my writing brought me to a full stop and stunted a lot of my growth for the last year and a half.

She was complimentary about my work, but she told me if I wanted to sell copies that I needed to shape it into a self-help book and to dumb it down to a middle school reading level. I was deflated. That wasn't at all the vision I'd had for the work I'd bled into, sweat through and gutted my soul out onto the pages. But, I knew she was the expert and I was not. She'd sold thousands of books and I've only had essays published. I felt I needed to consider her advice.
Books have a way of birthing themselves to some degree. My book has grown organically into part memoir and part self-help, if for no other reason than I offer information and resources as a natural progression of my story. I was loathe to chop it into short chapters with three alliterated bullet points  and a cheesy anecdote...and trying it felt forced and disingenuous. As every writer does, I write with a certain cadence, vocabulary and tone- and it's not far off from how I speak. It hit me hard to think that I'd have to 'dumb it down' in order to connect with my audience.

But I can't let it just sit. I've had too many interactions with people who want and need to hear what I have to say to keep it to myself; and I'm ready to move forward into being a more vocal advocate for mental health. I pulled out my manuscript yesterday and read through it. I was relieved to still connect with what I wrote and found it powerful and captivating. It's tough to read personal work- it's a pull back into dark times when life was scary, confusing, traumatic and chaotic. Much of what I had written was taken from my journals; entries often written with clinical sterility, solely for the sake of charting my son's moods. But those entries jog my memories, and the the memories give way to the words pouring onto the pages. Rereading them in part is reliving them, but with the scratchy comfort of having come through it and the knowledge that somehow we've made it.

I'm meeting with a friend weekly- one who pushes me and texts and gets on me when I'm not completing the goals I've set for myself. I've wanted to have my work published and to have the chance to speak in front of groups again for years; but I've allowed fear and the words of other people to hold me back. I'm tired of waiting for permission. I'm annoyed with myself for the myriad of excuses and reasons as to why now isn't a good time. I'm done letting my work sit in a drawer. I have no idea if anyone other than my family and few close friends will ever read what I write, but I know that I can't keep spinning my way around this universe year after year without trying. I don't have a new year's resolution, but I do have a promise to myself- to finally try. To give myself the chance to do what I've always wanted to do. To keep meeting with my friend, keep setting goals, keep writing a paragraph at a time, and to see where it leads me. In fact, that's one of the reasons I'm writing here. Goal #2 for this week has now been met.
I may not ever be a best selling author, but I refuse to be one of the bazillions of writers who are 'going to write a book one day'. I want to be able to look at myself proudly in the mirror, so for me, pursuing what I love has become a vital part of my well being. So instead of 'new year, new me'... I'm choosing to embrace 'new year, true me', and find out what happens when I just keep putting one foot in front of the other.
Cheers to showing up for our real lives!