Mental Health Monday–Goin’ to the Psych Ward


 

Blogger and aspiring author, Christine Danek, asks Lydia and I a series of questions about what would happen after someone attempts suicide. Be sure to check out Lydia’s response to acute management of an overdose.

I’m going to focus on two questions in particular:

“I plan to put [my character] into a psych ward shortly after she is treated. What is the procedure there? What type of medication would [my character] be given?”

In the state of New York, every person admitted to an inpatient psychiatric unit is given a particular legal status. Basically, it boils down to two choices: Voluntary or Involuntary. Voluntary hospitalization is simple enough. The person elects to be admitted to the psych ward. Involuntary hospitalization is more complicated in that the person does not personally elect to be admitted. The Mental Hygiene Law allows a physician to do an Emergency Admission if someone is presenting as an acute risk of harm to self or others.

I point out this is New York’s procedure because each state has its own laws. Other states do not have the option of Involuntary hospitalization, whether or not they plan to kill themselves or harm someone else. There are laws (Tarasoff I and Tarasoff II) that outline a clinician’s Duty to Warn and Duty to Protect, but that’s another post altogether.

Once the legal status is determined, other admission paperwork is completed such as a written document of the history and physical, medications to be ordered, diet, labwork, observation level, and a treatment plan outlining various treatment goals. The person is shown to their room (they often have a roommate) and oriented to the unit (where the dining room is, where the group room is, where the rec room is, etc).

Most inpatient psychiatric wards have daily group programming where patients participate in mental illness education groups, exercise groups, recreational therapy groups, medication education groups, and relaxation techniques (to name a few).

Someone who has attempted suicide, but no longer feels suicidal could be monitored on Q15 minute checks (someone checks in on the person every 15 minutes, round the clock). If the person still feels suicidal, then they may be put on a 1:1 sit, meaning someone literally sits with them and follows them around 24/7 until they are no longer a risk to themselves. A person can have what’s called bathroom privileges (where the sitter doesn’t follow them into the bathroom), or they may not have bathroom privileges, depending on how acute the situation is.

The person would have 24/7 access to nursing and support staff. They’d meet with the treatment team (usually consisting of a psychiatrist, social worker, nurse, and/or nurse practitioner, psychologist, etc depending on which facility the person is admitted to) on a daily basis to discuss their progress, if the meds are working, if there are any side effects, and to determine a discharge plan with follow up care.

Regarding medications, each medication regimen is individually determined. If someone is diagnosed with depression, they’d likely be prescribed an anti-depressant. If they have Bipolar disorder, they’d be prescribed a mood stabilizer. If they have a psychotic disorder, they’d be prescribed and anti-psychotic. If they have an anxiety disorder, they’d be prescribed an anxiolytic. Often, people have more than one psychiatric issue and are prescribed a combination of the above meds. Alcohol and illicit substance use is also commonly seen and each person is monitored for signs and symptoms of withdrawal. They are treated accordingly for symptom management.

I could go on and on, but I think that’s enough for now. If anyone has any further questions, let me know!

As always, remember this is NOT to be construed as medical advice or treatment. This is for writing purposes ONLY!

 

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14 comments on “Mental Health Monday–Goin’ to the Psych Ward

  1. Informative post. Great question. I think it’s great you answered it.

  2. Thank you so much. You gave me wonderful detailed information. I really appreciate you taking the time out. I’ll be sure if I have any other questions in this area to come to you. 🙂
    Have a great day!

  3. carolkilgore says:

    I followed the question here from Lydia’s blog. Thanks for the great answers.

  4. Ciara Knight says:

    I worked acute psych (locked ward) at the VA in Miami. Procedure is the same there. Interesting post.

  5. Kerri Cuevas says:

    Very interesting! I’m curious now on other states procedures.

  6. Rose says:

    Would it be possible to go into a bit more detail about what kinds of questions the patient is asked and what might be expected of them in order to be considered stable enough for discharge?

    Muchas gracias!

    • lbdiamond says:

      Safety is first! The team would check in with the patient frequently regarding any thoughts about harming themselves (or others), they’d follow up on how the medication is working, if there’s side effects, and they’d help the patient develop a discharge plan including outpatient treatment. Having a strong support network set up is crucial for reducing risk of a recurrence of symptoms after discharge.

      • Rose says:

        Thanks for the reply. I’m also wondering what they do if a patient doesn’t seem to have any family support, or if there’s anything they can legally do besides set up an outpatient appointment?

        I’m guessing the doctors and nurses get a feel for patients after working in such an environment for any length of time. Are they able to act on hunches regarding risk or are the procedures pretty much set in stone?

        Again, thanks for your time! 🙂

  7. Lydia Kang says:

    Thanks Laura!
    It’s funny, when I worked in NY we also called the person who sat by the bed a “1:1”. We had them for patients who were at danger of severe falls or confused behavior on the medical ward.
    But out here in Nebraska, they looked at me funny when I said “1:1”. Here they call it a sitter (which sounds less technical but more…parental, I guess.)

  8. lbdiamond says:

    Glad to be of help! Let me know if you have any other psych related questions. I’d be happy to feature them on my Mental Health Monday posts. 😉

  9. Thank you. This is very interesting. My son has bipolar, anxiety disorders, and ADHD, and has been suicidal a few times. In the state he lives in, Florida, he was Baker acted a few times, which sounds similar to what you describe. I would have assumed that all states would have treated him with involuntary admission. Thank you for new information. This time he was found unconscious on the side of a road and transported to an emergency facility and then to a Psyche ward for a few days. Had they not been able to treat him against his will, he would have died. Life is the stuff of novels, isn’t it?

  10. lbdiamond says:

    Rose–each situation is case dependent. The team does a risk assessment (taking into account how the patient is doing, what risk factors are present, what protective factors exist, and what history can be obtained from the patient, previous providers, etc). No one can predict the future and people will do what they do, but we try to make a successful plan as possible. 😉

  11. Nice to meet you. I found you through Lydia who found me first. An interesting post. My brother-in-law had schizophrenia. He was also married with twin daughters getting ready to graduate high school. His doctor changed his medication and he became suicidal. In March of that year he attempted suicide. The doctor did not take him off the medication. In may he was successful in his attempt at suicide. One of his daughters found him. I have long believed that doctor to be responsible.
    Nancy
    N. R. Williams, fantasy author

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