5 Ways to Support a Loved One During a Psychiatric Hospitalization

Stained glass image of hands and hearts
Credit: Morguefile

Having a loved one hospitalized on a psychiatric unit can often be an emotionally bewildering experience, one in which it’s hard to know just how to help. Here are a few suggestions.

Note: Hospitals vary widely in terms of policies. When in doubt, call ahead or consult printed visitor information.

1. Bring delicious food when you visit.

No. seriously. This is my top tip with good reason. Hospital food is generally dreadful on all units, but psych patients frequently have less flexibility in terms of what and when they can eat (no “room service,” more regimented mealtimes).

Bring something flavorful to combat the menu’s bland tedium, or a favorite coffee order from the lobby cafe. (Indian food and Starbucks made my evening when I had visitors.)

Just remember — no glass or non-plastic cutlery, for safety reasons.

2. Provide games or other activities to help pass the time.

Menus aren’t the only tedium. Supplies of magazines, puzzles, and card games on units are often paltry and uninspiring, so a “care package” of engaging, non-triggery reading material and some easy pastimes will be much appreciated. (I’m particularly fond of intricate mandala coloring books.)

As an added bonus, fun activities serve as an excellent icebreaker or distraction from the potential awkwardness or emotional charge of a visit. My nurses were much amused by the raucous game of Cards Against Humanity my friends and I once had going in my room!

3. Assist with practical needs outside the hospital walls.

Does your loved one need help with childcare? Looking after pets? Paying of bills? These are all stressors that can make it difficult for a hospitalized person to focus on his or her recovery.

Basically, offer any support and assistance you would if the person had a physical illness that required inpatient care. This will go a long way towards normalizing and destigmatizing psychiatric distress, which benefits everyone.

4. Help with transition planning.

Discharge from the hospital can often feel sudden and abrupt. To lessen your loved one’s overwhelm, offer concrete supports like rides to follow-up appointments or prepared meals the first few days. Arranging these in advance, while your loved one is still inpatient, can be a real anxiety-minimizer.

Note that the person may not be able to articulate just what they might need, so suggest possible ideas, dates, and times (“Would you like me to drop off a meal on Wednesday?,” etc.)

5. Be prepared for a range of emotions and expressions.

Your loved one may be angry, particular if the hospitalization is an involuntary one. He or she may be sedated or agitated due to medication side effects, and find this embarrassing or frustrating.

You will no doubt have your own range of difficult emotions as well. But doing your best to cultivate a reassuring, non-judgmental stance will go a long way towards preserving your connection with your loved one.

If you have any suggestions you’d like to add, either from the perspective of a mental health consumer or a friend/family member, I’d love to hear them in the comments.

“What do you want from us?”: Invalidation in Psychiatric Systems

Photo of hospital gurney.
Credit: Morguefile

This is how it works:

You stuff your backpack full of underwear and reading material in case you have to wait in the ER for 2 days again. You hug your kid goodbye and tell her that you’re off to a doctor’s appointment (not exactly a lie, but still). You ride the bus to the hospital for 2 hours, dozing from your sedative with your head against the window, headphones on for the last few minutes of music you may get for a week.

When “Hounds of Love” comes on, with the lyric “Hold me down, it’s coming for me through the trees,” you think in your haze: Yes.

You prepare yourself to spend this beautiful sunny afternoon in a windowless cubicle, hungry and thirsty, possibly bereft of your street clothes and phone. You practice the words you’ll need to tell them when they offer a simple Ativan tablet, or day treatment:

“I know myself. I need to be locked up.”

They offer you Ativan. They offer you day treatment. Even after you explain to them that you live in a rural town 25 miles away and don’t drive. “Take a cab,” they suggest.

If you still had any shred of a sense of humor left, you’d laugh. You’ve taken a cab home from their outpatient clinic before — once, and only once. A single trip cost almost $100. You’re on SSDI. That’s a ton of money.

“Oh,” they say.

You remind them that you have attempted suicide in the past. Over ten years ago, sure, but the memory of that ambulance ride haunts you still. You don’t want to get to that point ever ever ever ever again, please God no. You will check yourself into a locked ward with a security camera watching your every move in your room before that happens.

“Are you suicidal right now?”

No. Just — just! — battling intrusive thoughts of self-harm 24/7. Exhausted. Your meds knock you out for a few fitful hours, leaving you useless. The moment they wear off, the voice in your head — yours, but twisted — hisses: You worded that email wrong. You’re a terrible failure of a mother. Only one thing left to do.

Slice your arms open. Slice your arms open. Slice your arms open.

They listen. They look at you, sitting cross-legged on a gurney, Articulate. Calm. (Only because you’re here, in a white cubicle with no shaving razors tempting you, the world stripped-down and soothing in its clinical boundaries. You would tell them that, except it might make you look like an attention-seeking “borderline.”)

“You’re a smart person,” they say abruptly. (There are two of them, both male, the social worker and the attending doc. Social worker tries to be empathetic but fails; attending’s just a cowboy.) “Just what do you want from us?”

I told you. I need to be hospitalized.

“You’ve got DBT skills.”

Yes, and they were life-saving. But I’ve been trying and trying and working them and working them and the thoughts still. won’t. stop.

They leave you alone while they make phone calls: to your psychiatrist, who you adore and call Best Shrink Ever, and your husband, who you adore and call Fearless Husband because, well, more than a little fearlessness is necessary in order to be married to you.

And back they come, bearing reports. “Your doc doesn’t think you’re a safety risk. Your husband doesn’t think so, either.”

Complete bullshit. Fearless Husband’s furious — a rarity for him — when you call him for confirmation. “What?” he fumes. “I never said that. I told them you needed to be inpatient.”

Next up: insurance company, because the almighty profit-mongers are of course in a prime position to make clinical decisions. A decision of no.

When you hear this, you burst into tears.

Faux Empathy asks gently, stupidly, “What’s going on for you right now?”

What do you think is going on, dumbass? I’m getting discounted and invalidated, and what’s worse, praised for my tenacity and resourcefulness in reaching out for help, only to be told it’s a sign that I don’t need any.

“You don’t meet admission criteria,” Cowboy Doc says flatly.

But you admitted me with these very same symptoms before. Have those criteria magically changed?

“Bipolar disorder and borderline personality disorder are a tricky gray area,” Faux Empathy says.

Ahh, there it is, the BPD trot-out. Never mind that said maligned diagnosis has been expunged from your chart by Best Shrink Ever, who, after taking a longitudinal inventory of your entire life in grueling detail, after treating you for five years, has determined that you demonstrate none of the criteria — that beloved word again! — save for self-harm.

But these ER guys have known you for a whopping half-hour. They hear you talk about the urges to cut, and see a previous admission less than a year ago, and make their quickie determination.

“Please,” you tell them. “Talk to my husband again. He says you completely misinterpreted his take on the situation. He knows me. I know myself. If you discharge me, I’ll be right back in here suicidal tomorrow. Can’t you just spare us all that part and send me upstairs now?”

Slow headshakes. End of the line, sweetheart, the social worker’s face sadly telegraphs.

Cowboy Doc is more blunt. “Look, I can’t in good conscience give you a bed when someone else is going to come in here floridly psychotic in a few hours, really needing one.”

Ouch. The message is clear: You don’t really need help. You’re wasting our time.

Across the hall, a guy comes in floridly psychotic. He’s yelling that he neither needs nor wants to be here.

“I’ll take his fucking bed if he doesn’t want it!” you call into the hallway, with a surge of desperation and cheekiness. No one answers.

It’s indeed the end of the line. You are told to call your husband to come pick you up. You are graciously allowed to wait in your holding cell rather than out in the lobby. You spend the next hour frantically relaying your situation on Facebook on your phone. Friends commiserate and rage on your behalf and completely non-jokingly suggest feigning homicidal urges in order to get admitted.

Normally, you would hurt yourself before ever dreaming of hurting anyone else, but Cowboy Doc has left you wondering about the wisdom of that policy. You would throw something, but you have a trauma history and are terrified of being put in restraints, plus there is nothing in your blessedly-blank cubicle to throw.

“I wish we had a bed for you,” your discharge nurse says mournfully.

You will be back in twenty-four hours. This time with your husband in tow for backup. This time truly suicidal, just as you knew you would be, your face tear-stained from sobbing to him that the system doesn’t care if you die.

You joke that it’s your version of date night. Fall asleep on a gurney, parked in the lobby because there are no rooms open. This time they take you seriously. You open your eyes to the sight of your usual inpatient doc — not Best Shrink Ever, but a wonderful one nonetheless.

“I think we need to do some meds tweaking,” she says softly.

“Upstairs?” you whisper back.

She nods. “Of course.”

If you weren’t so sedated, you would weep in relief and gratitude.

The next morning, you wait 2 hours for an Ativan top-up while the staff deals with the angry guy across the hall who doesn’t want to be there. “Call me sir!” he screams. “I won’t cooperate unless you call me sir!”

You give up on the call button and drift. A few minutes later, a nurse comes in with a paper cup and your Ativan. “I’m really sorry,” she says. “I hate that people like you who want to be here get neglected.”

Me, too, you think. Me, too.