Heads exploding from a day at the psychiatrist - advice for possible hospitalization?

[Smile]

I had a hard day yesterday. I saw a new psychiatrist and he seems to be fantastic. I am very lucky bc he’s a fortune but happens to take take my cheap insurance. I didn’t sleep at all the night before and spent 6 hours in his office. A lot of information was given to me and he provided me with a few options. But the “best” option seems to be me electing to enter the psych ward of one if the best hospitals in America, which happens to be local. He thinks I may be able to get in with my insurance. I have some physical things going on as well so he thinks that if I’m in a hospital setting, I can get all my meds worked out. He‘d like me to be in for 4-6 weeks but is not sure the hospital will keep me that long. That’s a long time, for me.

It’s my choice but out if all the choices, this seems to make the most sense to me... no matter how scary. And I do mean I’m crippled with fear.

What makes it hard that much harder is that I’m living with my mom temporarily and she’s one school so I knew I had to be extremely careful with what I told her and how I worded it. I didn’t tell her 99% of what went on but did tell her about the hospital (had to, she may wonder if I just go missing) but I exchanged “hospital” for “some sort of inpatient program”. She didn’t seem too happy even with that so yeh, glad I didn’t tell the truth on that one.

But see, I’ve NEVER been hospitalized for psych. I’ve only ever heard scary, not fun stuff about it so I’m scared and I don’t think it’s an illogical fear.

Also, do I tell my close friends & family or not? A part of me doesn’t want them to think of me as crazy while another part wants to stand up to the prejudices and tell them with pride (if I can find the pride in it).

I’m also petrified that the doc is going to diagnose me with BPD (no insult to anyone who has it, only awe for you. I just don’t wang ANOTHER diagnosis. I’ve wondered about whether I have it but haven’t told anyone but then yesterday the doc said something that made it sound like he wanted to find that out too.

Now that just sent me spiraling. Usually the things I focus on and drive myself nuts over don’t come true. But now there’s a real possibility. I’m trying sooo hard not to think about it until my next appointment with him next week when I can just ask him but it’s so hard.

Even when not actively thinking about it, I’m paralyzed by an all consuming fear. Honestly, fear is my go to emotion for pretty much everything but this is different. It’s based off real possibilities. And I just don’t know how to get out of it.

And man oh man, living with my mom and constantly having to hide this from her... it’s so against my nature. I hate lying, hate covering things up.
I don’t know how to function in this moment.

I truly hope I didn’t insult anyone here, that was definitely not my intention ?

I know many of you have been hospitalized so I was just hoping for some advice on it all.
Thanks ??

 

[Sideways]

Does your psych have a clear plan of what he wants to achieve during your inpatient stay? That’s crucial for me, because unless it’s an acute safety issue, hospitalisation can be really counterproductive.

Private hospital though is a completely different experience from acute hospitalisation. Yes they have their rules (for your safety, and theirs), but very quickly it often starts to feel like a reasonably safe space to just mentally crash and have that “it’s okay to not cope right now” experience that a lot of people need... Depending on the quality of the unit.

Early in the relationship with a new pdoc, I’ve found hospitalisation can be super helpful. You can cover a whole lot of ground in a very short time - stuff that can take months and months to work out in weekly appointments. Medications, diagnosis, treatment and recovery plans - you can cover a whole heap of issues, with good accuracy, safely and quickly. That’s a definite bonus from my own experiences.

Again, completely different to an acute admission.

For me personally? 4–6 weeks would be too long, because of the post-discharge issues that come up from longer admissions. But again, that’s stuff you can cover with your treatment team on admission.

When I go to hospital? I tell people that need to know: “I’m in hospital”. People that know me, know I mean I’m in a psych ward. But it’s just a hospital. So that’s what I call it, and if a person has issues with that? That’s their issue, not mine.

But I don’t tell everyone. Because “everyone” doesn’t need to know, wouldn’t tell you if the tables were turned, and aren’t entitled to the personal and confidential information anyway.

If issues come up with mum because of your admission? That would be super normal, and 4-6 weeks is actually long enough to make some plans about how to manage that issue with mum moving forward. For me, I included my parents in a lot of conversations with my treatment team in the early years of my illness, because we needed to work together, rather than at odds, for practical reasons.

I personally got a lot out of my initial private, planned admissions. There was a lot of in-house psychotherapy provided (which I dissed at the time, but now absolutely value), we covered a shittonne of different medication options in a short period of time, and it was a space that I ultimately safely worked through hard, hard issues relating to employment, housing, and my important relationships, as well as getting some really good opinions on my diagnosis.

Would I recommend it for everyone? Nope. Hell no. Being able to continue functioning IRL is really important to good mental health, and the hospital environment can make that really difficult to pick up again on discharge. Hospital is also a place where some people pick up new, bad coping skills, without even realising.

So it comes back to - does your pdoc have a clear plan for what he wants to achieve during your inpatient stay? It sounds like this place will have in-house programs during the day to help you along (they feel dumb and pointless and irrelevant at the time - they aren’t!), so if there’s a plan for the outcome pdoc is looking to achieve? Then it sounds like a good opportunity, and worth considering.

ETA If you decide to go with this option? Check with pdoc if there are dieticians, social workers, and psychologists that you can see while an inpatient. Put aside “I don’t really need all that support”, and be greedy. Take every opportunity for different kinds of assistance that are available. Milk the opportunity as much as you can, because the resources available can help make huge, helpful changes that you didn’t even realise you’d benefit from, and you’re as entitled as any other patient to every kind of assistance on offer.

 

[Kubash16]

Everything Sideways said. I understand the fear of it, I chickened out several times then ended up involuntary. It ended up being the one time I have felt this complete safety that I have never ever felt before. It was definitely scary with it being a new environment and all the docs and nurses know your business and you know you are constantly being watched. But with all that, for me anyway, came a certain comfort. I was allowed to not be okay for a little while and not be judged for it, I got a lot of support instead. It’s scary, but man was it worth it. If I’m to that point again I will absolutely voluntarily go back in.

 

[joeylittle]

A lot of information was given to me and he provided me with a few options. But the “best” option seems to be me electing to enter the psych ward of one if the best hospitals in America, which happens to be local. He thinks I may be able to get in with my insurance. I have some physical things going on as well so he thinks that if I’m in a hospital setting, I can get all my meds worked out.

Does the psych have admitting and treatment privileges at this hospital? If not, did he talk about how he would handle co-ordination of care?

Early in the relationship with a new pdoc, I’ve found hospitalisation can be super helpful. You can cover a whole lot of ground in a very short time - stuff that can take months and months to work out in weekly appointments. Medications, diagnosis, treatment and recovery plans - you can cover a whole heap of issues, with good accuracy, safely and quickly. That’s a definite bonus from my own experiences.

Again, completely different to an acute admission.

Just echoing this piece @Sideways wrote - it's completely true. As I said above, you just need to ascertain whether or not this psych is going to be your doctor in the hospital. It may be fine if they aren't, but you'd want to know that upfront.

 

[Smile]

Does your psych have a clear plan of what he wants to achieve during your inpatient stay? That’s crucial for me, because unless it’s an acute safety issue, hospitalisation can be really counterproductive.

Private hospital though is a completely different experience from acute hospitalisation. Yes they have their rules (for your safety, and theirs), but very quickly it often starts to feel like a reasonably safe space to just mentally crash and have that “it’s okay to not cope right now” experience that a lot of people need... Depending on the quality of the unit.

Early in the relationship with a new pdoc, I’ve found hospitalisation can be super helpful. You can cover a whole lot of ground in a very short time - stuff that can take months and months to work out in weekly appointments. Medications, diagnosis, treatment and recovery plans - you can cover a whole heap of issues, with good accuracy, safely and quickly. That’s a definite bonus from my own experiences.

Again, completely different to an acute admission.

For me personally? 4–6 weeks would be too long, because of the post-discharge issues that come up from longer admissions. But again, that’s stuff you can cover with your treatment team on admission.

When I go to hospital? I tell people that need to know: “I’m in hospital”. People that know me, know I mean I’m in a psych ward. But it’s just a hospital. So that’s what I call it, and if a person has issues with that? That’s their issue, not mine.

But I don’t tell everyone. Because “everyone” doesn’t need to know, wouldn’t tell you if the tables were turned, and aren’t entitled to the personal and confidential information anyway.

If issues come up with mum because of your admission? That would be super normal, and 4-6 weeks is actually long enough to make some plans about how to manage that issue with mum moving forward. For me, I included my parents in a lot of conversations with my treatment team in the early years of my illness, because we needed to work together, rather than at odds, for practical reasons.

I personally got a lot out of my initial private, planned admissions. There was a lot of in-house psychotherapy provided (which I dissed at the time, but now absolutely value), we covered a shittonne of different medication options in a short period of time, and it was a space that I ultimately safely worked through hard, hard issues relating to employment, housing, and my important relationships, as well as getting some really good opinions on my diagnosis.

Would I recommend it for everyone? Nope. Hell no. Being able to continue functioning IRL is really important to good mental health, and the hospital environment can make that really difficult to pick up again on discharge. Hospital is also a place where some people pick up new, bad coping skills, without even realising.

So it comes back to - does your pdoc have a clear plan for what he wants to achieve during your inpatient stay? It sounds like this place will have in-house programs during the day to help you along (they feel dumb and pointless and irrelevant at the time - they aren’t!), so if there’s a plan for the outcome pdoc is looking to achieve? Then it sounds like a good opportunity, and worth considering.

ETA If you decide to go with this option? Check with pdoc if there are dieticians, social workers, and psychologists that you can see while an inpatient. Put aside “I don’t really need all that support”, and be greedy. Take every opportunity for different kinds of assistance that are available. Milk the opportunity as much as you can, because the resources available can help make huge, helpful changes that you didn’t even realise you’d benefit from, and you’re as entitled as any other patient to every kind of assistance on offer.

Wow, thanks for all of that!!! Quick question: you said, “4–6 weeks would be too long, because of the post-discharge issues that come up from longer admissions.”
Can you explain please? Specifically post-discharge issues?

ETA If you decide to go with this option?

I’m not sure. I think soon, like in 2 maybe 3 weeks?

Does the psych have admitting and treatment privileges at this hospital? If not, did he talk about how he would handle co-ordination of care?

I don’t know and not really... yet. Will ask next visit thanks!!

 

[Smile]

This may sound silly but I’m a smoker. What’s the situation with that? Am I allowed to? Am I allowed outside?? Can I bring them in with me? Actually, can I bring ANYTHING in with me? Like do I wear my own clothes or is it hospital gowns? God I want this over with already... too scary

 

[joeylittle]

This may sound silly but I’m a smoker. What’s the situation with that? Am I allowed to? Am I allowed outside??

Not silly. In the US (is that where you are?), policies around smoking differ greatly from state to state, and hospital to hospital. This is the sort of question that you may be able to find the answer to on the hospital's website, in the area specific to inpatient psych treatment. If it's not there, you'd need to be asking someone who works in that area - it's probably a question you can ask the psych.

Actually, can I bring ANYTHING in with me? Like do I wear my own clothes or is it hospital gowns?

Again, this will depend on the hospital, your treatment plan, how much separation they have for their inpatient populations, and what risk you are at for self-harm. You mentioned it's a hospital with very robust mental health services - so, my guess would be that you'd be wearing your own clothes that would need to conform to what they suggest you bring (this is usually soft, comfortable, and some rules about specific types of clothing), and you'd probably be allowed some personal items. The website might host this info, either in a FAQ area, or a 'preparing for admission' area.

God I want this over with already... too scary

New is always scary. But the fact that you're local to a good hospital is a really big deal - let that give you some sense of security. Also, if you decide to go forward with this, you'll have discussed the treatment plan with your psych.

Do you have a follow-up appt. set with them?

 

[EveHarrington]

None of the hospitals I have been in have allowed smoking. Everyone who smoked was given the patch.

 

[Sideways]

Can you explain please? Specifically post-discharge issues?

In good hospitals, you’ll find that your discharge planning begins on admission. Which seems weird.

But the hospital environment has a few significant elements that are different from home life, which people get to feel safe in very quickly. They’re typically low-stimulus environments (both in design issues and management of day-to-day), they provide you with structure and routine even when you’re rock bottom, there is company whenever you need it, and there’s a nurse assigned to checking you’re okay, anywhere from twice per shift to every 10-15 minutes depending on what your doctor writes up.

All of those things change the second you go home. And even though you’ll be looking forward to going home, there are some hard realities that your system has to automatically readjust to: loads of uncontrolled stimulus, no routine, no structure, limited company, and no one checking “are you okay” throughout the day.

That’s surprisingly tough to readjust to. A lot of people find that they have a mood dip for a short period after they go home. And if it’s not managed well, in really difficult cases it can cause the person to bounce straight back into hospital.

Discharge planning is really important for that reason. I’ve done years of hospital admissions, so I know that for me, an admission longer than 2 weeks will cause real mood issues going home. Other people, particularly if they don’t live alone, can go much longer and not have serious issues.

Planning how you manage that period should be part of the discussions you have with staff during your stay, so that you have extra support to make the transition home. 6 weeks is definitely long enough that the transition home needs a plan.

 

[Smile]

it's probably a question you can ask the psych

Thanks!! Seems small but another small load off my head so ??

Do you have a follow-up appt. set with them?

Not sure I understand the question. You mean with the psychiatrist? I have an appointment in a few days , yes... if that’s what you meant.

I just wanted to thank you so very much for your EXTREMELY in-depth reply. It was sooo helpful and knowledgeable. Mucho ??

Not silly. In the US (is that where you are?)

And yes, in the US. New York :)

 

[Smile]

None of the hospitals I have been in have allowed smoking. Everyone who smoked was given the patch.

Thanks!... definitely not the answer I was looking for but helpful ??‍. Were you allowed to go outside?

 

[Smile]

In good hospitals, you’ll find that your discharge planning begins on admission. Which seems weird.

But the hospital environment has a few significant elements that are different from home life, which people get to feel safe in very quickly. They’re typically low-stimulus environments (both in design issues and management of day-to-day), they provide you with structure and routine even when you’re rock bottom, there is company whenever you need it, and there’s a nurse assigned to checking you’re okay, anywhere from twice per shift to every 10-15 minutes depending on what your doctor writes up.

All of those things change the second you go home. And even though you’ll be looking forward to going home, there are some hard realities that your system has to automatically readjust to: loads of uncontrolled stimulus, no routine, no structure, limited company, and no one checking “are you okay” throughout the day.

That’s surprisingly tough to readjust to. A lot of people find that they have a mood dip for a short period after they go home. And if it’s not managed well, in really difficult cases it can cause the person to bounce straight back into hospital.

Discharge planning is really important for that reason. I’ve done years of hospital admissions, so I know that for me, an admission longer than 2 weeks will cause real mood issues going home. Other people, particularly if they don’t live alone, can go much longer and not have serious issues.

Planning how you manage that period should be part of the discussions you have with staff during your stay, so that you have extra support to make the transition home. 6 weeks is definitely long enough that the transition home needs a plan.

W.O.W! That is fascinating and makes perfect sense. You explained it so well, thank you thank you thank you! I’m definitely going to bring a notebook with questions...
The way you make it sound actually gets me almost excited to do it already. One thing that’s been bothering me is that I’ve been googling for patient reviews of this specific hospital but can’t find much. You wouldn’t happen to have any advice on that?

You’ve been soo very helpful, I feel rude asking for more of your help but you just seem so knowledgeable :)