A Family Guide to Psychiatric Hospitalization

• How do I know when my loved one needs to be hospitalized?
• What's the difference between voluntary and involuntary hospitalization?
• How can I convince my loved one to check in to the hospital?
• How can I help a loved one who is hospitalized?
• How can I be supportive after my loved one comes home?
• How can I prepare for the future?

When does a person need psychiatric hospitalization?

Symptoms of mania or depression can seriously interfere with a person's life. Sometimes hospitalization can be the best option to keep the person safe and stabilize severe symptoms.

People may need to go to the hospital if they:

• threaten or try to take their lives or hurt themselves or others.
• see or hear things (hallucinations).
• believe things that aren't true (delusions).
• need special treatments such as electroconvulsive therapy.
• have problems with alcohol or substances.
• have not eaten or slept for several days.
• are unable to care for themselves or their families, e.g., getting out of bed, bathing, or dressing.
• have tried treatment with therapy, medication, and support and still have a lot of trouble with symptoms.
• need to make a significant switch in treatment or medication under the close supervision of their doctor.
• have any symptom of mania or depression that significantly interferes with life.

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What's the difference between voluntary and involuntary hospitalization?

Voluntary hospitalization takes place when a person willingly signs forms agreeing to be treated in the hospital. A person who signs in voluntarily may also ask to leave. This request should be made in writing. The hospital must release people who make requests within a period of time (two to seven days, depending on state laws), unless they are a danger to themselves or others. If your loved one asks to be released and the hospital does not comply, your state's protection and advocacy agency can help you with your next steps. Most psychiatric hospital stays are from five to ten days. There are also longer residential rehabilitation programs for alcohol or substance abuse, eating disorders, or other issues that require long-term treatment.

Involuntary hospitalization is a last resort when someone's symptoms have become so severe that they will not listen to others or accept help. You may need to involve your loved one's doctor, the police, or lawyers. Involuntary hospitalization is an option of last resort only. It is better to talk with your loved one before a crisis and determine the best treatment options together. Work with your loved one in advance to write down ways to cope and what to do if symptoms become severe. Having a plan can ease the stress on you and your loved one, and ensure that the appropriate care is given.

How can an advance directive or a medical power of attorney help?

An advance directive and a medical power of attorney are written documents that give others authority to act on a person's behalf when that person is ill. Your loved one can specify what decisions should be made and when. It is best to consult a qualified attorney to help with an advance directive or a medical power of attorney. These documents work differently in different states.

Click here to see a sample Advance Directive.

How can I find out more about hospitalization for a family member?

• Your family doctor or psychiatrist may be able to explain things.
• Your local hospital can tell you about admission policies.
• Your local police (call the non-emergency number if you are not in crisis) can explain how they handle this type of situation.
• A lawyer who specializes in mental health law can give you some advice.
• The Treatment Advocacy Center can explain involuntary commitment laws in your state.
• Your state Protection and Advocacy Association can let you know your options.
• Your local Depression and Bipolar Support Alliance support group may have members who have similar experiences to share.

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How can I convince my loved one to check in voluntarily?

• Talk with your loved one about the behaviors you have seen that indicate to you that the hospital may be a better place for them right now.
• Explain that hospitalization is intended to create a safe place to allow severe symptoms to pass and medication to be adjusted and stabilized. It is not punishment and it is nothing to be ashamed of.
• Reassure your loved one that the hospital is a safe place where a person can begin to get well. No one outside the family needs to be told about the hospitalization.
• Tell your loved one that getting help does not mean someone has failed. A mood disorder is an illness that needs treatment, like diabetes or heart disease. Hospitalization is nothing to be ashamed of.
• Call the hospital and find out more about admission, treatment, and policies.
• Help your loved one pack comfortable clothing and safe items that are reminders of home.
• Offer the person choices, such as going to the hospital with you or with another loved one.

How should I talk to a person in crisis?

• Stay calm. Talk slowly and use reassuring tones.
• Realize you may have trouble communicating with your loved one. Ask simple questions. Repeat them if necessary, using the same words each time.
• Don't take your loved one's actions or hurtful words personally.
• Say, "I'm here. I care. I want to help. How can I help you?"
• Don't say, "Snap out of it," "Get over it," or "Stop acting crazy."
• Don't handle the crisis alone. Call family, friends, neighbors, people from your place of worship, or people from a local support group to help you.
• Don't threaten to call 911 unless you intend to. When you call 911, police and/or an ambulance are likely to come to your house. This may make your loved one more upset, so use 911 only when you or someone else is in immediate danger.

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How can I help a loved one who is hospitalized?

Find out when people are allowed receive phone calls and visits. If your loved one wants you to, stop by to say hello and bring a book, comfortable clothing, slippers, food, or something else your loved one likes. Check with hospital staff first. Some items (mirrors, belts, drawstrings, spiral notebooks, some grooming items) may not be allowed.

Know that your loved one may not want to see anyone at first, and respect those wishes.

Ask if the hospital offers a family support group.

Learn about your loved one's illness, its symptoms, and its treatments. Remind yourself that your loved one has an illness, not a character flaw, and it is not anyone's fault. If you don't know your loved one's diagnosis, find out more about mental illness in general.

Help your loved one make a list of questions about the illness and treatment to ask the doctors or hospital staff.

If your friend or family member is not getting good care from the hospital, say something. Ask the staff to explain the treatments your loved one is getting. If he or she is getting unnecessary or experimental treatment, ask that it be stopped. Don't be afraid to ask more than once for good treatment for your loved one. Stay calm but be persistent.

Ask if your loved one needs you to help with things like housework, care for children or pets, or phone calls to an employer during the hospital stay.

How can I get answers to questions about my loved one's treatment?

There may be privacy regulations at the hospital that will keep you from finding out about your loved one's treatment. These rules are there to protect your loved one, not to keep you out. Ask hospital staff what you can do to find out more. Your loved one may be able to ask that the restrictions be removed.

There will probably be several professionals treating your loved one. This may include a psychiatrist, therapist, social worker, psychiatric nurse, and psychiatric technician. It may be difficult to reach hospital staff who can give you information about your loved one, especially at the beginning of treatment. You may need to try several times before you reach someone who can help you. Keep trying.

Write down the name of your loved one's psychiatrist and therapist, and other hospital staff that work with your loved one, and the best time to reach them with questions. Write down the questions you have and the answers you are given. Keep questions specific and to the point. Be patient, polite, and assertive. Ask for clarification of things you do not understand.

Keep a record of your communications with hospital staff, including the times of calls, who you talk to, and what you find out. If the staff is not responding, try calling the ombudsman or hospital administrator. If possible, schedule a meeting for you, your loved one, other family members, and hospital staff to talk about treatment and other concerns.

Before your loved one is released, make sure there are written instructions for treatment, e.g., what medications should be taken and when, who to see for follow-up care and when, and what professionals are available in case of emergency. Write down any changes in diet or activity your loved one needs to make because of treatment.

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How can I be supportive after my loved one comes home?

• Believe in your loved one's ability to recover. Your belief in your loved one can make a big difference. Show your support by being kind, available, and dependable. Many people say their families' faith in them kept them going through difficult times.
• Help your loved one prioritize bills, housework, and other tasks so he or she doesn't feel overwhelmed.
• Ask what your loved one needs; don't assume. Ask if you can help with daily tasks, give medication reminders, or come along to health care appointments.
• Respect your loved one's boundaries. Be available when he or she is ready to accept your help.
• Be patient. Don't rush, pressure, hover, or nag. It may take some time for your loved one to feel better. A person may have temporary side effects such as dizziness, upset stomach, headache, or trouble sleeping when starting a new medication.
• Give your loved one a DBSA Personal Calendar to track medications, moods, and patterns.
• If your loved one is in school, help with make-up work and special accommodations.
• If you live far away, show your support with phone calls, cards, and letters. Talk with the person's health care providers and other loved ones who live nearby about how you can help.
• Get support for yourself. It helps to talk to people who know how it feels to be in your situation. Call DBSA at (800) 826-3632 or visit DBSAlliance.org/findsupport to find a support group near you. If there is no group nearby, DBSA can help you start one.

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Preparing for the Future

• Keep a list of phone numbers, including your loved one's doctor, therapist, and psychiatrist, your local hospital, and trusted friends who can help.
• List the warning signs that your loved one may be having a severe episode. List things he or she might say or do, and what you can do to help.
• List the treatments and medications that work and don't work for your loved one.

You are not alone.

Supporting a loved one with a mood disorder can be difficult, but you can have a positive impact on your loved one's wellness. Help your loved one cope before, during, and after hospitalization. Help him or her find the best treatment. Get support for the entire family, and never give up hope.

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