How to prepare for an in-patient stay
In-patient stays, when a person gets admitted to a specialised ward for treatment of mental health issues, can be scary for everyone involved no thanks to popular culture and the stigma that has resulted from these references. It can be really hard to try and find positive stories or depictions of psychiatric units or wards, which when you think about the fact they are often a very important tool in recovery from mental health issues, is a massive shame at best, and a national disgrace at worst.
How we think about mental health wards and what happens behind closed doors can seriously affect our judgement and ability to recognise the really important role they play in healthcare in the UK, and can sadly mean that all too often they are seen as the option to be avoided at all costs, rather than a sensible solution to a very serious problem. It can mean that, instead of seeing them as part of a positive treatment journey, we avoid talking about them and multiply their fear factor by a thousand.
On a personal level, it can mean we discourage our loved ones from thinking or talking about them, tell ourselves we will have failed if inpatient support is required, or worry we have lost our loved ones for good.
All of which means that when this became a reality for our family (and far later than it should have done because of said fears) I was particularly worried about the impact it would have. I’m ashamed to say that I felt all of these fears around how my mum would be treated, whether she’d ever come out again, if we’d be able to visit her, and whether she would be safe. I also remember some discussions with family members about whether a stay on a ward would make her ‘worse’, which, considering we were having this discussion after a crisis point which resulted in physical harm, was as ludicrous as it sounds.
For weeks I wrestled in my head with the reality that my mum was a patient on a psychiatric ward, and about how that felt for me and my family. There was a mix of disappointment that we hadn’t managed to stop it (which I’ve never experienced before if my family members have needed hospital care…) a fear that she’d never come home again, and a worry about what people would say and think. All this, while going through the utterly devastating heartbreak of seeing someone you love suffer such incredible pain and fear.
Fast forward 3 years, and 3 in-patient stays later, and I cannot tell you how differently I think now.
In-patient stays provide so much and I regret that we ever pushed the option so far down the list that we didn’t see whether we could have benefitted from it sooner. They are still scary because they represent the unknown, and separation from family and friends - but they also offer support, space, time for reflection, wonderful staff who’ve seen your situation a thousand times before and make you feel less scared, a time for rest for family and friends who desperately need to top up resources, a chance for a proper review of the situation in a safe environment, and most of all, a chance of recovery from some of hardest, lowest places a person might be.
When we went through our first admission, I wish there had been a place I could take all these fears and questions and get some answers. As I’ve learnt a bit more about the routines and realities of supporting someone through an admission, stay and discharge, I now realise I have those answers myself and could be sharing them.
So here are some suggestions, based on my experience, of what you might do to prepare yourself if an in-patient stay looks likely, and how you can get the most out of a really important time for your loved one, and you too.
Imaging me whispering the word research, because I think this needs some caution - but I definitely found that doing a bit of googling, seeing some pictures about the ward itself and getting an idea of it was helpful. Because we’re not very good yet at being comfortable with psychiatric hospitals, even the idea of one was terrifying to me. Turns out, they are usually in lovely grounds, with outside space, and look like the rest of hospital buildings. Who knew!
..But please be careful with your research and be clear what you’re looking for. People do leave reviews for hospitals like they leave reviews for everywhere else, but remember that people are much more likely to leave a bad review than a good one. If you want to do some serious research, looking at the most recent CQC inspections can be a good place to start. These things can all be found fairly easily online.
Know as much as you can about what ‘type’ of admission is being planned/discussed. Rethink, Mind and others have amazing information on this, but essentially you need to know whether it will be an informal admission, or done under a section. This will give you an idea of the rights you have as a loved one of someone admitted, and what to expect next
If it’s practical, see if you go and view the ward or at least the grounds, before an admission. Sometimes it can be hard to know when an admission will happen, but there are other times when there are a few days to prepare, and so getting a ‘feel’ for the place can be quite helpful and put your mind at ease. Is it a new building, what are the surroundings like, where will your loved one sleep and what might they see out of their window? These are all things it helped me to know about, and made knowing that I had ‘left’ them there a little bit easier
When the admission happens, do your best to find out what to expect in terms of day to day running of the ward as possible. On most hospital wards, there will be set visiting times, places to see your loved ones, rules about what you can safely bring onto the ward etc etc. A psychiatric ward is no different, so the sooner you can familiarise yourself with these policies, the better prepared you’ll be to plan your support around them and work together with the staff on the ward to get the most out of the stay
As well as finding out what the practical rules are, also try and get a sense of how the ward works, what activities are on offer, and what sort of approaches to treatment they might want to take. It can be hard to feel like you’re handing over control of a situation you’ve been so involved with, but finding out how the staff want to work with your loved one can help take some pressure off and remember, these people are professionals, and they have done this many, many times before
In order to have a good relationship with the staff on the ward and to do your best to work together, it might be a good idea to introduce yourself and give them any background they need. I typically do this about 3 or 4 days after admission, when the dust has settled a little bit, and I can get in touch and give (and get) names, contact details, any useful things to know etc. This can help with knowing who to call if there’s an issue, but also helps them understand who might be calling and visiting, and what life outside the ward looks like for your loved one
One thing you might want to think about in those few weeks is also how you want to talk about what’s happening and what people feel comfortable with. For all sorts of reasons, your loved one might not want people to know they’re in hospital, or you might not want to tell people for fear of judgement. You also might be desperate to tell people but aren’t sure how they’ll react, or even what words to use. I definitely struggled when people were confused after I told them my mum was in hospital with severe depression as people weren’t sure what that meant. Take the time to think about how much information you’re comfortable with giving, what questions you’re happy to answer, and how much privacy you need. It’s really important for you to feel supportive of the admission if you can, and these are all things that have an impact.
Remember that an in-patient stay is not a punishment or a failure by you to take care of someone and make them better. For every illness, there is support that you can give, and then support you need to ask for. People train for many years to provide that support, so asking for their help is not failure, it’s just smart. Too often we make the assumption that it has to be out job to ‘fix’, but I know from experience that we’ve only experienced full recovery when we’ve allowed everyone to play their part
Keep one eye on discharge and remember that this is when your role might switch again and you might find yourself doing a bit more of the heavy lifting. Discharge can be a difficult time for everyone as you’re likely balancing a lot of emotions about what comes next, and the fear of ‘going backwards’ looms large. That’s ok. Take the time to plan out what you need to plan for and give yourself the time and energy to do it.
Remember you don’t just have one roll of the dice! Given the fluctuating nature of most mental health problem, there may be a time when another admission is needed. This does not render everything that came before it useless. As I’ve said before, in-patient stays can be a hugely effective tool in recovery and living well with mental health issues, so it’s perfectly feasible that a person might need more than one stay if a situation deteriorates. If that’s you, your own checklist and process will start to become second nature to you
..and the best piece of advice I can possibly give you in preparing for an in-patient stay is to allow yourself some time to rest. Your loved one will be safe, and by doing some of the steps above, you’ve helped yourself understand what the next few weeks or months might look like. This is now your chance to switch off a little bit and catch up on sleep, snacks, laughing, running, sex, Netflix and whatever else you might have missed. Caring is an exhausting thing to do - and whilst you won’t want to step back fully, and might very well have others to look after - creating some small changes at this point can be really helpful. For example, I altered my work pattern during my mum’s in-patient stays to ensure I had a block of time to myself mid-week, and also made a few more plans with friends which I knew I’d be more able to keep as I had a bit more energy in the tank.