What to Expect With an Inpatient Hospitalization

The purpose of inpatient stays is to stabilize individuals enough to be discharged to outpatient care. If a child has been referred to an inpatient facility from an emergency room (ER), he or she likely will be transported there by ambulance once an available bed has been located. (This can take a day or two, especially if you arrived in the ER late in the day, near a holiday or on a Friday. Older teens may be eligible for an adult unit, however, choose an adolescent one whenever possible as the severity of illnesses typically is more extreme in adult facilities.) A parent should be allowed to ride in the ambulance.

Some hospitals have short-term observation units, which can hold youth for up to 72 hours and are often called Comprehensive Psychiatric Emergency Programs (CPEP). CPEPs provide a few days to assess whether a child at high risk requires inpatient treatment. Not intended for therapy, they offer 24-hour observation. If you have time while a decision is being made about your child, return home to get his/her toothbrush, toiletries (nothing in glass bottles), pajamas (without drawstrings), underwear, socks, slippers or shoes without laces, and several days’ worth of clothing. (Do not bring anything that is his/her favorite since the items likely will later be tainted in his/her mind by association with the hospital or inpatient facility.) Include magazines, puzzle books and other forms of entertainment as electronic devices will not be permitted in the ward.

An intake assessment will take place upon your child’s arrival at the inpatient facility, during which you will be asked about your family’s history of mental illness. It is crucial to be honest as genetics play a significant role in mental health. (If your child enters the facility on the weekend, he/she likely will not be evaluated by the unit’s regular team until Monday.) Determine the circumstances under which the facility will contact you. Typically this will be when [1] your permission is needed for a new medication for your child (If you do get a phone call about this, record the date, time, doctor’s name and specifics of the conversation.); [2] your child has been involved in an “incident” (Ask for details. For example if he/she was taken to a seclusion room, did he/she go willingly or was he/she taken by force and were restraints used? Write the information down, including the date, the caller’s name and what led to the episode. If possible, try to get an account of what happened from another witness and talk to your child later to obtain his/her version.); or [3] it is time to have a “family meeting” to discuss discharge plans, typically several days to a week before your child leaves the facility.

A staff member will sort through your child’s belongings to decide what can stay. Anything glass, sharp or long enough to tie around a neck (including belts, drawstrings and shoelaces) will not be allowed. Some facilities conduct body checks to establish an inventory of existing scars and wounds. Afterward, your child will be taken to his or her room and you should be permitted to say goodbye. Doctors will then develop a working diagnosis for your child and he/she probably will have a regular daily schedule that includes brief check-ins by medical staff, a few hours of school and group therapy. The main goal will be to provide structure, medication and monitoring. If your child already has a psychiatrist, make sure that he or she is in touch with the inpatient doctors throughout the hospitalization.

While your child is there, you will be able to call the nurses’ station whenever you want to find out how he/she is doing, to ask questions or to request that a doctor or social worker contact you. Questions to ask when the facility prescribes medication include: What is the doctor’s reason for choosing this specific medicine?; Are there any alternatives?; How long will it take for the medication to work? (For example, antidepressants may not reach their full potency for 4 to 6 weeks.); and What are the most common side effects, how long do they usually last and are there any rare, but serious ones of which you should be aware? Maintain a record of medications, when dosages are altered and any notable modifications in behavior. (This can help prevent future doctors from trying prescription drugs that your child has already used.) Because some changes may not be visible until after your child is discharged, his or her outpatient psychiatrist should be included in any decisions about medication that are made at the facility.

Psychiatric units typically are locked with a two-stage door system. You will have to show identification to enter, phones with cameras likely will be banned in order to protect patient privacy, and the visitor list for your child may be limited to family only. Seeing your child on the weekends, when there is less structure and activities, is advisable. If you bring food, ask in advance about what is allowed and use a paper bag as plastic ones usually are not permitted. Be pleasant to the staff and try to get to know as many by name as possible.

Parents typically have intense feelings about their children being in inpatient facilities, which can include anger, fear, guilt, relief, sadness and/or shame. Processing your own emotions will allow you to better help your child, who probably will feel afraid, ashamed and confused about being at a mental health facility and may take that frustration out on you. Try acknowledging and empathizing with his/her emotions (rather than responding to his/her hurtful words) by saying “I bet you are scared.”, “You must be angry you have to be there.” and/or “You sound miserable. I am sorry it is so hard.”

Your child’s discharge date will be influenced by your insurance coverage. During the family meeting, which usually is attended by parent(s), the child, a social worker and a psychiatrist, take extensive notes and create a safety plan with the facility and your child’s treatment team. (If your child was suicidal and/or made an attempt, you need to ask how much of any new medication(s) would cause an overdose.) Identify the warning signs that readmission might be necessary and have follow-up care, like an appointment with his or her mental health care provider, in place before your child leaves.

If your child received any psychological testing during his/her hospitalization, get a copy of the results before you depart. Obtain the discharge instructions and make sure you sign a release indicating that you want the discharge summary when it is ready, specifying where you would like it to be sent. Upon returning home, help your child feel normalized and supported by empathizing with and listening to him or her without judgment, shame or stigma. Finally, consult with your child’s treatment team to determine how quickly he/she can resume normal activities; how long he/she can be left alone; if visits to friends’ houses are okay (or should they initially take place at your home?); and how you can transition back to any previously existing levels of independence.