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!