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.

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.

Waiting To Exhale

I keep waiting.

When you've lived in chaos for years and years, you learn to expect the moment when the proverbial 'other shoe will drop'. I hold my breath, wondering when it will fall, when the ease will shift and gusts of harsh winds will blow back into our lives... yet, the atmosphere remains calm.

It's amazing to me how humans can adjust to incredibly overwhelming circumstances; surviving through trauma and danger and stress that you'd expect to level a person. I've written recently about how I found myself submerged in depression last fall, and the heaviness and dark shadows that wouldn't lift. The sun has found its way back into my eyes and when I ruminate on what took me so deeply into the bleak desert, I recognize that while Samuel was away, there was space for me to fall apart. I'd held my breath for 14 years- bracing against all manner of aggression, wildly swinging moods, his sensory overload, the effort to keep everyone safe, and the ongoing fight for the services he needed. When he wasn't there, my brain was able to shut down at some level, preserving itself and refusing to operate at the intensity it had been forced to endure for so long. I'd had high hopes of all I would change and accomplish in his absence; creating the structure and routine in our lives that had been lacking due to the ever changing emotional atmosphere, spending more time being present with my other three kids who have lived under the cloud of mental illness and autism their entire lives, finding space for myself- with yoga and prayer and time in nature. I did some of these things, and we certainly made progress, but by the end of the summer I hit a wall and I couldn't have cared less about much of anything. I had nothing left. I'm an intensely feeling person, and found myself numb to most everything. It was foreign, and only increased the hopelessness.

Bringing him home was scary. He'd done so well in the highly structured environment of the treatment facility and I knew that after 9 months away, there would be many adjustments he'd have to make on a daily basis. His therapist had warned both of us that there was usually a honeymoon period of a couple of weeks and often times her patients would wind up back in the hospital for an acute stay within the first 6 weeks. When she'd said that, my stomach dropped. He's had 5 hospital stays since the age of three, and my naive hope had been that the residential treatment would have vaccinated us against the need to return to acute treatment; yet, I was grateful for the warning. I brought him home with the knowledge that he could completely fall apart in the reintegrating of his life.

Earlier this week he hit the 6 week mark.

The air I'd been hoarding inside my body has found its way out, and the exhale is intoxicating. I've realized that when I've been asked how he's doing, my response is beautiful. He's doing incredible. The work he put in while he was away; educating himself about his illness and autism, learning some of his triggers and how to cope with them or eliminate them, his ability to be self aware of his emotions and the response his body is having to stimuli, his powerfully articulate communication when he's felt hurt, or angry, or confused... it's nothing short of miraculous. Before he left he had been a wreck. He had never had the proper diagnoses- at least, not at the same time- and he wasn't getting the support and services he so desperately needed. He'd unraveled to the place of destruction, and our lives were spent barely surviving the daily trauma of improperly treated mental illness. I'd had the police at our home, he'd been admitted into the hospital after an ER visit that we'd made under police escort, he was failing the 9th grade despite his incredible brilliance, he'd been suspended three times in 5 short months of high school, and he was defiant and mean. I was desperate. Terrified for my child and the road we were headed down.
Residential treatment saved our lives.

I left a broken, angry, ill equipped, improperly treated child with a devastating disease and 9 months later was given a young man who does what I ask him to, serves me even when not asked, is excelling in his new school even in honors classes, and whose laughter that had once died now echoes off of the walls. We've had minor bumps. He's a 16 year old boy after all! But we've navigated them in a way that still takes me by surprise. A couple of weeks after he'd gotten home I'd unknowingly said something one evening that hurt him. I hadn't been aware of it, and had gone to bed as usual. He woke me up before 6 the next morning and said he'd had a hard time sleeping and had to talk. He told me that I'd hurt his feelings, that he knew I hadn't meant to, but he needed me to know. I blinked the sleep out of my eyes in wonder... who is this young man?! We talked it through and had a normal day- free from violence, rage, anger, depression or cursing- old responses he'd had when upset or offended.
Life with him home feels so... normal. Average. Safe. We still work hard, and he has a therapist who comes to the house three times a week for three hours each time. Our lives are still vastly filled with work and school and the management of his illness and autism, but they're also so good. Watching him with his siblings and seeing the anxiety of not knowing what the day would hold for them in regard to his mood begin to fade is beautiful. I'm not living in a fantasy world where I believe that we'll never have another crisis or trauma related to his illness.. Bipolar 1 and Autism cohabiting inside of his brain is a bitch. There's no other way to say it. They work in tandem to exacerbate the symptoms of each disorder; But. I have hope now. I can see the potential for a life for him that isn't driven by chaos and being defined by his illness. I can see the weight lifting off of all of us as we learn to live and love as a family outside of continual trauma and drama. I can see peace in his eyes and his body- peace that has settled deep into his marrow, stilling him and grounding him and allowing him to receive our love. He helped create his own miracle. His incredible effort and positive attitude about getting better fueled the change in him and has been a gift to himself and his family.
I realize I may have a painful post in the future about some possible crisis we may experience- and that's ok, as I know that's how life unfolds for all of us, but for today, for now, the waiting is over, and I can finally breathe in the beauty, and then deliciously.... exhale.