Psychiatric inpatient care questions

[swimmermom3]

If you or someone you know well has been involved in psychiatric inpatient care, could you please answer a few questions for me? PMs would be fine.

 

Please do not quote for privacy issues.

 

A family member is currently in an inpatient behavioral health floor of one of our local hospitals. There was a mental health hold that expired on Tuesday and the patient elected to stay because it was recommended. "Treatment" has included an hour meeting with psychiatrist per day and... not much else.  Patients are allowed their cell phones and they are not required to attend any of the classes or leave their rooms. We think this would be problematic for the chronically depressed or the anxious who wouldn't wish to leave their rooms anyway. However, patients are told that the more they participate, the earlier they will be allowed to leave. In the three full days the patient has been there, the daily "caring for Yourself" class has been cancelled twice. Tonight, while we were there, the "Learning About Yourself" class was cancelled in order to have a "Sports Appreciation" night - read the staff wished to watch the NBA finals.  Earlier today patient and another new patient went in search of the "Managing Your Illness" class only to find the door locked. The "new" patient (psyche wards are old hat) had the wherewithal to march up to the nurses' station and say ask how he could "grow and heal" if there were no classes. A staff member obliged and our patient said the class was very helpful.

 

Most of the serious classes that are skill building seemed to not happen on a regular basis. There is no outside space and the only exercise opportunity offered is a "Movement" class with some yoga, but is mostly for elderly patients.

 

Do we have a basis for being angry that this program was mandated as a necessary part of the healing process. We've been down this road before, but only with an outstanding outpatient program that was heavily skill-based.

 

The care seemed incredibly half-assed.  Medical care was supposed to be scheduled for tomorrow and after we made some noise, it happened promptly this evening. All I could think was if our patient was even more ill and we had not been to this rodeo before, it could have been a really bad experience. I really feel for patients who want to get better and are offered so little to work with. Is this typical? Would it be appropriate to send a letter to hospital management? What if they won't refer the patient to the good outpatient program? How can we work around them?

[hornblower]

:grouphug:  sending you pm

[Jean in Newcastle]

Typical.  But yes, I would write the letter and I would cc. the doctor in charge of care.  Who does the actual referral come from?  Most hospitals do have hospital social workers who can work with you as well.  

[ondreeuh]

I'm so sorry. In our big city, there are two programs. One is a voluntary (unlocked) unit in a hospital, which is excellent. Regular classes, lots of therapy, art activities, movies, very structured. I think the only exercise they do is a group walk around the hospital. No cell phones at all, but letters and visitors are allowed.

 

Expected stay is about 2 weeks for most patients, but there were teens who were there longer while looking for a more permanent placement. The other program LOOKS good on paper but I have heard so many negative things about the actual experiences there.

 

Yes, I would complain and list as many specific examples as you can. Cancelled classes & no group therapy would be a HUGE deal to me.

[Luckymama]

Wth?!

 

:grouphug:

[Pegs]

It sounds pretty typical of an adult ward, IME. Sorry. :(

 

I've seen such units used to contain a patient while their crisis passes, and/or so that a patient can be kept under observation while the treating psychiatrist trials/tweaks/dabbles with medications.

 

You can PM me if you'd like to ask anything specific more privately.

[SparklyUnicorn]

typical, but you certainly have a basis for being angry

 

Frankly, those places are more like prisons or holding cells.  Hell, maybe prisons offer more.  Probably not, but I have wondered.

 

 

[livetoread]

My only experience was working as a psych tech on weekends at one hospital. Your description does not fit my experience. We had lots of structured time and patients were strongly encouraged to attend most of it (we would go into rooms and jolly them into coming out.)

 

However, IMO, the primary goal was getting them through the crisis so they can function enough to get outpatient treatment. Life skills are lost on someone who is actively psychotic, catatonic, or deeply depressed. Managing meds while keeping them safe was the purpose, and if you were well enough to benefit from the classes, that was good too, but you were probably close to discharge anyway.

[SparklyUnicorn]

 

However, IMO, the primary goal was getting them through the crisis so they can function enough to get outpatient treatment. Life skills are lost on someone who is actively psychotic, catatonic, or deeply depressed. Managing meds while keeping them safe was the purpose, and if you were well enough to benefit from the classes, that was good too, but you were probably close to discharge anyway.

 

This seems to be the case/purpose in my experience.  That it's more just something to stabilize someone medically. 

[jjeepa]

I would recommend contacting the Patient Advocate at the hospital to set up a meeting to address your concerns.  From my experience working at an inpatient psychiatric hospital for many years, meeting with the Patient Advocate is often more effective and productive than meeting with anyone else.  They should be able to meet with you within a very short time frame.  

 

 

[SparklyUnicorn]

The family member is fortunate to have people to advocate for them.  This doesn't just happen in psychiatric situations.  Part of my job as social worker in a nursing home was advocating.  Especially for those who had nobody.  Those who had family paying attention and advocating for them got what they needed.  Others often did not.  It was very depressing.

 

 

[Chris in VA]

Agreeing that hospital stays are for stabilization. Level of care in many places is sad. They will keep patients safe, usually. IME, that's about it.

There are better programs out there, but IME, they are longer term and private.

 

I would be pissed, too.

Hugs to you and yours--hard road to walk.

[Big Buckin' Longhorn]

I have a close family member who has unfortunately had many mental health crises.  The worst places are the public health and/or hospital facilities.  Fortunately she does have excellent insurance (and is financially stable) and we are generally able to get her moved to private facilities most of the time, but only after the immediate crisis had passed.  A family member (read: me) needs to be there every day demanding/overseeing appropriate care.  It's so sad but so true.  And I do not believe this is only true of mental health. Whenever anyone in my immediate (or extended, if I can manage it) family has to be hospitalized for any reason, I make it a priority to never leave them alone in a medical facility.  If I can't be there, I'm on the phone coordinating with other family members to share times.  I've had too many experiences where the care level is just sub par if an assertive advocate is not always in the immediate vicinity.  It's sad, but it's my true experience. 

 

And I am not sure if what you are experiencing is average or not, but it I am certain it is unacceptable and you should raise as much noise as possible to see that your family member is provided a more healing environment.