Are you feeling confused and overwhelmed trying to navigate a complex hospital system for your loved one?
Have you been wanting answers about the hospitalization and discharge process, but aren’t sure how to find them?
If you answered yes to the above questions, you’re in the right place!
There are a lot of reasons why someone you love may be hospitalized for behavioral health reasons, and the spectrum of positive and negative experiences with hospitalization is quite vast. Your loved one may be hospitalized with voluntary or involuntary status. It may have been a smooth process for them to get admitted and you trust the care they are receiving, or it may have been traumatic, and you’re extremely dissatisfied with the outcome. Perhaps you are somewhere in between.
Your loved one may be getting adequate support and assistance with their discharge and aftercare plans, but that isn’t always the case. After nearly a decade working in inpatient behavioral health settings, I have extensive knowledge in this area to help individuals and families navigate the hospitalization system. Below I will help outline a guide for what to expect when a family member is hospitalized, what you can do to support them, and how you can help them transition home when they discharge.
Common Reasons for Inpatient Hospitalization
Let’s start with the reasons someone might be hospitalized. To justify inpatient behavioral health admission, the individual must meet at least one of the following: a danger to themselves, a danger to others, or have a grave disability. The list below isn’t exhaustive, but here are some examples:
Immediately following a suicide attempt (danger to self)
Active thoughts of harming themselves with intent and/or means or a plan to act on it (danger to self)
Not feeling they can keep themselves safe at home (danger to self)
Treatment resistant depression (danger to self)
Depression impacting ability to function and meet daily needs (danger to self, possibly grave disability)
Unable to meet basic needs of obtaining food, shelter, and clothing (grave disability)
Experiencing a manic episode (possibly all three)
Psychosis or psychotic break (possibly all three)
Violence, property damage, or legal issues caused due to mental health reasons (danger to others)
What to Expect from a Hospitalization
The primary goal of hospitalization is safety and stabilization. Stabilization doesn’t mean they are void of their symptoms, but they are at a place where it can be safely managed in a less restrictive environment outside of the hospital.
An average length of stay for someone voluntary would be 1-2 weeks and 2-4 weeks for someone involuntary. This can certainly vary, as voluntary patients occasionally stay for just a few hours if they wish to be discharged immediately after arriving, or possibly if they are involuntary and get let go from the mental health court system the next day. On the flip side, it’s not completely uncommon to take a month or several months for some patients to stabilize and be safe to leave.
Hospitals provide 24/7 care with a treatment team made up of psychiatrists, nurses, social workers, and occupational or recreational therapists. The team discusses new patients that arrive, and the psychiatrists approximate an estimated discharge date that continues to get updated as progress is made. They meet daily with each patient on their caseload and assess symptoms, medication side effects, and discuss changes to be made to help them get to a place where no major med changes are being made, so patients can get back towards baseline.
Social workers determine the patient’s individual needs, from housing to mental health care to insurance and many other community resources. They problem solve barriers to care to help patients have a follow-up plan to help prevent readmission and update the team on potential safety concerns that could impact the targeted discharge date.
Nurses usually have a lower patient ratio and can offer more 1-1 support for patients. Their role involves administering meds, making sure patients’ basic needs and ADLs are met, and helping deescalate crises that occur.
Depending on the hospital, several disciplines are running groups, but generally occupational or recreational therapists are typically dedicated to facilitating various group therapy for patients to teach coping skills, leisure education, self-esteem, mindfulness, and some light cognitive behavioral or dialectical behavioral therapy. There is usually no individual therapy that can be offered in inpatient settings due to staffing and the nature of the environment.
Impact on You
I want to take a moment to discuss the impact watching a family member go through hospitalization has on the caregivers themselves. It can be very scary, overwhelming, frustrating, and anxiety-provoking. It can bring up strong emotions and you may feel helpless with wanting your loved one to get better, but not being able to control their symptoms improving faster.
It’s necessary that you utilize proper supports for yourself, continue doing your activities and maintaining your sense of routine and normalcy. Hopefully, you feel your loved one is safe where they are, and you can remind yourself of this when things get hard. Please know you are doing the best you can. Even if they can’t thank you for your efforts, it doesn’t go unrecognized. It’s ok to take a break or miss visiting hours when you need to get some rest in. Give yourself permission and it will help manage the guilt you may feel for them being there. This is temporary.
What You Can do to Support
You know your loved one best. It’s important to advocate for their needs, especially if they aren’t able to do so themselves. Do they need more time and are you not ready to have them home yet? Is staying longer negatively impacting their well-being and do you need to advocate for a sooner discharge?
You can ask for a family meeting or a call from the psychiatrist to get more information and hear updates on their plan, but also try to be patient in them getting back to you. They do need to prioritize discharges happening first, but it is reasonable to receive an update on a plan for discharge and any updates if things change.
Request referrals/resources from the social worker but be prepared to make calls and schedule yourself. Social workers are extremely busy and have many other patients on their caseload, so being able to take the recommendations and help move forward with setting up aftercare can help ensure your loved one will be equipped for discharge.
Helping them Transition Home
Discharge day is here! For some, this is a huge relief that your family member is returning home, and you are ready to receive them and help. For others, this may be tenuous and anxiety-provoking. Maybe things weren’t left on the best of terms, or they are still symptomatic and aren’t 100% stabilized. Perhaps there are concerns if they will agree to take their meds or attend mental health follow-up appointments. Regardless of where you land with your loved one, here are some ideas to help with a smooth transition:
Discharging can be very overwhelming and exhausting. Offer additional compassion if they need more time to rest or take it easy within the first 48 hours home, but this should not be an expectation that is how things will be.
Keep in mind they went from a highly structured environment with meals, meds, and groups at scheduled times, and it can feel strange to lose that. Try to factor that in and help keep up with healthy structure.
Set and maintain boundaries with what you are needing to see from them and ask what their needs are and how you can best support them.
Did they create a safety plan in the hospital? Make a plan to discuss this within the first 72 hours of discharge. If not, create one with them so you can both follow this.
Ensure they attend follow-up appointments with a medication provider and therapist. If they don’t love that idea, use whatever they are motivated by to help encourage them to engage, such as staying out of the hospital if they attend their appointments.
Additional Resources for Navigating Hospitalization
I hope this guide was a helpful start to navigating the very complex hospital system, knowing some ideas of what you can keep in mind to assist your loved one along the way, and how you can prepare for them transitioning back to the community. What discharge recommendation was most useful for you?
If hospitalization is not the right fit at this time, a great resource in King County is Connections Kirkland, offering 24/7 support, crisis stabilization, and walk-in mental health services. They can help evaluate if your family member may need inpatient, or offer some immediate resources and assistance without pursuing hospitalization.
The King County Behavioral Health and Referral Division has a comprehensive list of community mental health agencies in Washington State that accept Medicaid if you’re looking for options for follow-up care for your family member.
If you’re looking for more support, I offer individual and family therapy for mental health caregivers supporting a loved one in crisis or with a chronic mental illness. Feel free to explore my mental health caregiver service page for more information. Schedule a free phone consultation if you feel ready to move forward!
If you’re a mental health professional and would like support with a specific case, I offer professional consulting services for this very reason! Please reach out and I’d be happy to work through a complex case with you.
Hi, I’m Michelle Solomon, owner of Roots of Compassion Therapy!
I hope you enjoyed this blog post. I come with over 10 years of experience in the mental health field. In my practice, I provide virtual therapy all across WA and in-person walk and talk sessions in South Seattle for adults with bipolar disorder, burned out healthcare workers and professionals, and family mental health caregivers. Please book a free consultation to get started with services, and I look forward to connecting with you soon!