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.