The Hospital: Making the Most out of Challenging Circumstances
Most people remember visiting someone in the hospital and few of
them will say that it was a pleasant experience. You don’t know where
you’re going. You don’t know where the bathrooms are. People seem
to be rushing all around you. No one seems to care if you know where
the room you’re looking for is. It smells different. You’re not sure what
you should touch and what you shouldn’t. There aren’t enough chairs in
the room. And no one will tell you anything so you don’t know if the person you’re
visiting is really doing well or not. And that’s just when you go to visit someone who
just had a baby.
That anxiety is compounded when the person you are visiting is in a psychiatric
unit, even more so if they were detained there after you - or someone else close to
both of you - called the Designated Mental Health Professional (DMHP) to evaluate
them because their behavior caused you to be concerned for their (or your) safety.
You don’t know what to expect from the environment—from visiting hours to the
general layout of the unit; from the staff—who are they and what do they do, who
are you supposed to ask questions of; from the other patients—will they be “tied in
wheelchairs” and screaming at you or will they be “all drugged up”; and most
importantly, from the person you are visiting—will they refuse to see you or yell at
you? Lots of questions go through the minds of visitors. Probably the most
important of which is “Should I even visit?”
The answer depends on many variables and the short answer is “Call the unit
and ask”. Some of the variables that affect the answer you will get are:
Mental status: A person’s mental status is comprised of 11 different components—
appearance, behavior, speech, thought process, thought content, mood, affect,
perceptual experiences, memory, insight, and judgment. Each component has its own
continuum of health. Where the person you wish to visit is in terms of each of those
components will impact how the staff answers your questions.
Medication: Most psycho-active medication creates some form of change for the
person on a sensory level. Some commonly reported problems are blurred vision,
dry mouth, a feeling of light headedness, a feeling of ‘lead in my legs’, the urge to
pace, and itchy skin. Some medications have sedative effects while others make one
more alert. While most of these responses to medications decrease over the course of a
few days, they may impact whether a person wants (or can tolerate) visitors.
Treatment: Psycho-social treatment takes many forms in inpatient treatment. For one
person it may be two days of almost uninterrupted sleep and for another it may be very
structured and highly interactive. Individual and group sessions are often scheduled at
specific times and having visitors on a psych unit during those times detracts from the
benefit to patients. Most units will make ‘special’ allowances for visitors from out of
town or those for whom visiting during designated visiting hours would be a hardship.
Other patients: Staff will always qualify their comments about visiting with some
phrase like ‘depending on what is going on at the time’. There is no way for them to
predict what every patient will do at every minute of the day so they must retain the
authority to prevent people from entering the unit based on what is happening at the
moment. Unfortunately sometimes the behavior of others put visitors in an
uncomfortable or unsafe position and ending the visitation is the safest action at the
time.
Unlike when visiting someone who just had a child, the person who is hospitalized
for psychiatric treatment may have little or nothing to say. For them, their life revolves
around the treatment they experience throughout the day and they may or may not
choose to share that information with you. Visitors often find that they have to ‘carry
the conversation’ and even then they run out of things to say after a few minutes.
Sometimes bringing a few ‘approved’ props helps give you something to focus on and
talk about. Remember : Visits do not need to use up the entire visiting time.
Sometimes it’s preferable to have short visits that the person can tolerate by engaging
with you rather than longer visits that are draining for everyone.
Visitors often like to talk with the staff before they depart and the most common
question is “How is s/he doing?” Be aware that the person can refuse to have any (or
all) information released and, no matter how much the staff wants to help you, they are
bound by the legal decision and wishes of their patient. Even though an individual
may be ordered by the Court to participate in treatment (and is “detained” to an inpatient
unit), that order does not change the individual’s right to determine who knows what
about them. Sometimes, in less than pleasant situations, the patient’s decision to
exercise his/her right results in the patient being discharged without the family being
notified. The only exception to that right is if the patient had threatened to harm a
specific person. In that case, the staff has certain legal responsibilities to inform specific
people of the discharge.
The fact that staff may not be able to provide information does not prevent them
from listening to any information that you have to offer about the individual being
treated—particularly if it may help unravel the mystery and get the person back on their
feet faster. There may be specific people (such as Social Workers) whose designated
role includes gathering history of present (and any previous) events and developing a
‘picture of the patient’ for the physician and other staff. Any information that you can
provide may be helpful to the treating team.
At the end of the day, remember this. The person you care about is hospitalized for
a good reason, as with any other kind of medical need. Their hospital stay should
promote their wellness and recovery, and you are an important part of that process. Be a
good partner and ally for both your loved one and their medical providers. This
dynamic will provide a good framework for the best possible outcome for all of you.
The fact that NAMI can help reduce the distress that people experience around
mental illness should be common knowledge in our communities. I look forward
to working with you to achieve this goal. Please feel free to contact me through
the NAMI Yakima office at 509.453.8229 or boardpres@namiyakima.org
|
