Understanding Hospitalization

We’ve been there.We can help.

for Mental Health

If you are experiencing severe symptoms of depression or bipolar disorder, a brief stay in the hospital may help you stabilize. This brochure is intended to help you through your hospitalization, as well as help family and friends be supportive. Some ideas may be useful to you; some may not. Everyone’s experience with hospitalization is different.

When do i need to go to the Hospital?You might consider hospitalization if you:

• Havethoughtsofhurtingyourselforothers

• Areseeingorhearingthings(hallucinations)

• Havebizarreorparanoidideas(delusions)

• Aresorevveduporimpulsivethatyouaredoingdangerousorharmfulthings

• Feeltooexhaustedorsloweddowntogetoutofbedortakecareofyourself

• Can’tstopusingalcoholorothersubstancesinharmfulways

• Havenoteatenorsleptforseveraldays

• Havetriedoutpatienttreatment(therapy,medication,andsupport)andithasn’thelpedorhasmadethingsworse

• Needtomakeamajorchangeinyourtreatmentormedicationundertheclosesupervisionofyourdoctor

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How Can Hospitalization Help?• Hospitalizationisintendedtocreateasafeplacetoallowseveresymptomstopassandmedicationtobeadjustedandstabilized.Itisnotpunishmentanditisnothingtobeashamedof.Onlythoseyouwishtotellneedtoknowaboutyourhospitalization.

• Youcanworkwithprofessionalstostabilizeyourseveresymptoms,keepyourselfsafeandlearnnewwaystocopewithyourillness.

• Youcanlearnskillstohelpyoumanageoverwhelmingfeelingsordisturbingthoughts.

• Youcansafelystopusingalcoholorothersubstances.

• Youmayfindanewtreatmentorcombinationoftreatmentsthathelpsyou.

What Might i expect?• Thereisnogeneralruleabouthowlongyou

shouldstayinthehospital.Youmaystayafewdaysoraslongasafewweeks,dependingonyoursituationandthespecifictreatmentyouarereceiving.

• Youmaybeinalockedunit.Atfirst,youmaynotbeabletoleavetheunit.Later,youmaybeabletogotootherpartsofthehospital,orgetapasstoleavethehospitalforashorttime.Thisisforyoursafetyandthesafetyofotherswithintheunit.

• Youmayhavejewelry,personalcareitems,belts,shoelacesorotherpersonalbelongingslockedawayduringyourstay.Youmaynotbeallowedtohaveitemswithglassorsharpedges,suchaspictureframes,CDcasesorspiralnotebooks.Evenifyoudonothavethoughtsofhurtingyourselforothers,theserulesareinplaceforthesafetyofothersintheunit.

• Youmaybeexpectedtofollowaschedulewithsettimesformeals,groups,treatments,medications,activitiesandbedtime.Aregularschedule,especiallyaregularwakingtimeeachday,canhelptostabilizeyourmood.

• Youmayhavephysicalormentalhealthtestsincludingbloodteststofindoutyourmedicationlevelsorlookforotherphysicalproblemsthatmaybeworseningyourillness.

• Youmaysharearoomwithsomeoneelse.

• Hospitalstaffmaycheckonyouorinterviewyouperiodicallytoassesshowyou’redoing.

• Yourregulardoctorortherapistmaynotbeabletoseeyourightaway.Youwillprobablytalktoseveraldifferentdoctors,nursesandstaffmemberswhileyou’reinthepsychiatricunit.

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Your time in the HospitalYoumightwanttoaskalovedonetohelpyouwithhospitalcheck-inproceduresandtofilloutforms.Youmaywantyourlovedtobeyouradvocateifnecessaryandaskthemtohelpyoucommunicatewithhospitalstaff.

Youoralovedonemayalsowanttocallthehospitalinadvancetofindoutaboutcheck-inproceduresanditemsyoucanbring.Askifyoucanbringmusic,soap,lotion,pillows,stuffedanimals,booksorotherthingsthatcomfortyou.Findoutaboutvisitinghoursandtelephoneaccess.Besureyourfamilyandfriendsareawareofhospitalprocedures.Letthemknowwhattheycandotohelpyou.

VoluntaryHospitalizationtakesplacewhenapersonwillinglysignsformsagreeingtobetreatedinthehospital.Apersonwhosignsinvoluntarilymayalsoasktoleaveattheirdiscretion.Rulesabouthowquicklythehospitalmustreleaseyouvaryfromstatetostate.Ifyouasktobereleasedandthehospitaldoesnotcomply,yourstate’sProtectionandAdvocacyAgencycanhelpyouwithyournextsteps.

InvoluntaryHospitalizationisanoptionwhensymptomshavebecomesoseverethatthepersonisincapacitatedormightbeadangertothemselvesorothers.Rulesaboutinvoluntaryhospitalizationvaryfromstatetostate.Inmostcases,youcannotbeheldlongerthanafewdayswithoutacourthearing.involuntary hospitalization is an option of last resort only.

Besurethepeopletreatingyouknowyourneedsandpreferences.Makethemostofyourtimewithyourdoctorbymakingalistofquestionsyouhaveaswellasyourcurrentmedications.Youmightwishtoaskyourlovedoneorhospitalstafftohelpyouwiththelist.

Letyourdoctorandstaffknowaboutanyotherillnessesyouhaveormedicationsyoutake.Besureyoureceiveyourmedicationsforotherillnessesalongwiththemedicationsfordepressionorbipolardisorder.

Letthehospitalstaffknowaboutyouruseofalcoholorotherdrugs.Hidingorminimizingyourrecentalcoholordrugusewon’thelp,anditcanevenbedangerous.

Itmaytaketimetogetusedtotheroutineinthehospital.Ifyoursymptomsaresevere,somethingsmaynotmakesensetoyou.Trytogetwhatyoucanoutoftheactivities.Concentrateonyourownmentalhealth.Listentowhatothershavetosayingroups.Keepajournalofyourownthoughtsandfeelings.

Youwillmeetotherpeoplewhoareworkingtoovercometheirownproblems.Treatthemwithcourtesyandrespect,regardlessofwhattheymaysayordo.Ifsomeoneismakingyoufeeluncomfortableorunsafe,tellastaffmember.

a note for loved ones: it is best to talk with your loved one before a crisis and create a preferred treatment directive 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.

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Know Your rights• Youhavetherighttohaveyourtreatmentexplainedtoyou,therighttobeinformedofthebenefitsandrisksofyourtreatment,andtherighttorefusetreatmentthatyoufeelisunsafe.

• Youhavetherighttobeinformedaboutanytestsorexamsyouaregivenandtorefuseanyproceduresyoufeelareunnecessary,suchasagynecologicalexamorotherinvasiveprocedures.

• Youhavetherighttorefusetobepartofexperimentaltreatmentsortrainingsessionsthatinvolvestudentsorobservers.

enlisting a Friend or Family Member to HelpYour loved ones may want to know how to help. Here are some ideas that you may wish to share with your friends and family:

ask if i would like visitors.Imaynotwanttoseeanyoneatfirst.Pleaserespectthosewishes.

Find out when i am allowed to receive phone calls and visits.IfIaskyoutocometothehospital,stopbytosayhelloandbringabook,comfortableclothing,slippers,foodorsomethingelseIlike.

ask if the hospital offers a family support group tosupportthemifyoufeelyouneedhelptoo.

learn about my illness, itssymptomsanditstreatments.Rememberthatthisisanillness,notacharacterflaw,anditisnotanyone’sfault.

Help me make a list of questionsabouttheillnessandtreatmenttoaskthedoctorsorhospitalstaff.

ask me if i need you to helpwiththingslikehousework,careforchildrenorpets,orphonecallstoanemployerduringthehospitalstay.

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Wellness after Hospitalization Know your treatment. Beforeyouleavethehospital,makesureyouhaveawrittenlistofyourtreatmentplan,includingyourmedications(dosageandwhentotakethem),talktherapy,personalwellnessstrategies,andavenuesforpeersupport.Findoutifthereareanyfoods,medications(prescription,over-the-counterorherbal),oractivitiesyouneedtoavoidwhiletakingyourmedication,andwritethesethingsdown.Trackyourtreatmentplanandmoods.DBSAoffersadownloadablePersonalCalendarat www.dBsalliance.org/publicationsoryoucantrackonlinewiththeDBSAWellnessTrackeratFacingUs.org/tracker.

Make sure your providers communicate. Checkwiththehospitaltomakesuretheysendrecordstoyouroutpatientcareproviders(medicaldoctor,psychiatrist,and/ortherapist).Ifyouroutpatientcareprovidersarenotpartofthesamesystem,youmayneedtosignreleaseformssotheycantalktoeachother.

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treatment & Mood tracking

Went to Group or Session 1 2 3 4 5 6 7

Talk therapy

Support group

Mood Level 1 2 3 4 5 6 7

Extremely manic

Very manic

Somewhat manic

Mildly manic or hypomanic

STABLE

Mildly depressed

Somewhat depressed

Very depressed

Extremely depressed

Mixed state (manic and depressive symptoms) — ✓ if yes

Medications Dose Per Pill (MG) Pills Per Day Prescribed 1 2 3 4 5 6 7

Seehowyourdailymoodsrelatetoyourtreatment.

Checkthedaysyougototalktherapyandsupportgroup.1

Listyourmooddisordermedications,howmanypillsprescribed,andhowmanyyoutakeeachday.2

Listyourmedicationsforotherillnesses,andanyothersupplementsyoutake.3

Fillintheboxthatbestdescribesyourmoodfortheday.Ifyourmoodchangesduringtheday,fillintheboxesforthehighestandlowestmoods.Connectthembydrawingalineorfillingintheboxesbetweenthem.Lookforpatterns.

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learn all you can about your illness. Talktoyourdoctoraboutnewtreatmentsyoumightwanttotry.Findoutwhattoexpectfromtreatmentsandhowyouknowifyourtreatmentisworking.Ifyouthinkyoucouldbedoingbetter,askanotherdoctorforasecondopinion.

Continue the routines that help you. Formostpeople,dailyroutinesorschedules(regulartimesforsleep,meals,physicalactivity)arehelpful.Ifyourstayinthehospitalhelpedyoutofindaregularschedule,itcanhelptostickwithitafteryoureturnhome.

take one step at a time.Youmightnotfeelbetterimmediately.Allowyourselftoslowlygetbacktoyourroutine.Giveyourselfcreditfordoingsmallthingslikegettingoutofbed,dressing,orhavingameal.Graduallyworktowardslargergoals.

prioritize the things you need to do.Concentrateononethingatatime.Writethingsdownoraskfriendsandfamilytohelpyoutokeepfrombecomingoverwhelmed.

set limits.Taketimetorelax.Ifyoufeelstressedorexhausted,youcansaynoorcancelplans.Scheduletimetocareforyourselfandrelax,meditate,takealongbath,listentomusic,ordosomethingelsethatisjustforyou.

Change can be good.Somepeopleareconcernedthattreatmentwillleadtolessproductivityorcreativity.However,manyhavefoundthattheirdecreaseinsymptomshasimprovedtheirabilitytofocusandhelpedthembemoreproductiveoverthelongterm.

stick with your treatment.Gotoyourhealthcareappointments,therapyandsupportgroups.Bepatientasyouwaitformedicationtotakeeffect.Youmayhavesomesideeffectsatfirst.Iftheycontinueformorethantwoweeks,talktoyourdoctoraboutchangingyourmedication,yourdosage,orthetimeyoutakeyourmedication.Neverchangeorstopyourmedicationwithoutfirsttalkingwithyourdoctor.Thiscanhavesignificantimpactonyourcurrentmoodaswellasthefrequencyandseverityofpotentialmentalhealthcrisesinthefuture.

recognize your symptoms and triggers.Feelingverydiscouraged,hopelessorirritablecanbesymptomsofyourillness.Ifyoufeelextremelyangry,yourmindstartstorace,oryoustarttothinkabouthurtingyourself,stop,think,andcallsomeonewhocanhelp.Keepalistofyourtriggersandwarningsigns,alongwithalistofpeopleyoucancallforhelp.

give relationships time to heal. Yourfamilyandfriendsmaybeunsureofhowtoactaroundyouatfirst.Theremayalsobehurtfeelingsorapologiesthatneedtobemadebecauseofthingsyoumayhavedonewhileinmaniaordepression.Yourfamilymembersmayfeeltheneedtoapologizetoyoufortheirresponses.Recognizethateveryonehasbeenaffectedintheirownwayandneedstimetoheal.Showthatyouwanttogetwellbystickingwithyourtreatment.EncourageyourlovedonestogetsupportfromaDBSAsupportgroupiftheyneedit.

Help your loved ones help you.Askforwhatyouneed.Tellthemspecificthingstheycandotohelpyou.Ifyouneedhelpsuchashousework,rides,orwake-upcalls,justask.

take it easy at work.Explaintoyoursupervisorandco-workersthatyouhavebeenillandyouneedtotakethingsslowly.Youdon’thavetotalkaboutyourdepressionorbipolardisorder.Ifsomeoneasksquestions,politelybutfirmlytellthemyoudon’twanttotalkaboutit.Doyourbestatwork.Trynottotakeontoomuchtooquickly.Onbreaks,callafriendorfamilymembertocheckin.

get support.Seekpeoplewhohavehadsimilarexperiencesandarefeelingbetter.ConnectwithahospitalaftercaregrouporDBSAsupportgroup.

Know wellness is possible.Afterhospitalizationitcanbeverydifficulttofeellikeyoucangetwell.Mostindividuals,withpropertreatment,dogoontolivefullandproductivelives.

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How Can i Find people Who Understand? DBSAsupportgroupsaremadeupofpeoplewithmooddisorders,theirfamiliesandtheirfriendswhomeettoshareexperiences,discusscopingskillsandofferhopetooneanotherinasafeandconfidentialenvironment.

dBsa support group participants say the groups:

• Provideasafeandwelcomingplaceformutualacceptance,understandingandself-discovery.

• Givethemtheopportunitytoreachouttoothersandbenefitfromtheexperienceofthosewhohavebeenthere.

• Givethemnewhopeandbeliefthatthey canrecover.

• Motivatethemtofollowtheirtreatmentplans.Helpthemunderstandthatmooddisordersdonotdefinewhotheyare.

• Helpthemrediscovertheirstrengthandhumor.

PeoplewhohadbeenattendingDBSAsupportgroupsformorethanayearwerelesslikelytohavebeenhospitalizedfortheirillnessduringthatyear,accordingtoaDBSAsurvey.

How Can an advance directive or a Medical power of attorney Help Me? Anadvancedirectiveandamedicalpowerofattorneyarewrittendocumentsinwhichyougiveanotherpersonauthoritytomaketreatmentdecisionsforyouifyouaretooilltomakeyourown.Itisbesttoconsultaqualifiedattorneytohelpyouputtogetheranadvancedirectiveormedicalpowerofattorney.Thesedocumentsworkdifferentlyindifferentstates.Youmaywishtovisitwww.dBsalliance.org/advancedirectivetoseeasampleadvancedirective.

How Can i Be prepared for a Crisis in the Future? Makeacrisisplanninglist.Youmaywishtoincludefamilyorfriendsinthecreationofthislist.Brieflydescribethekindofhelpyouwouldliketoreceiveifyouhaveseveresymptomsagain,including:

• Yourdoctor’snameandcontactinformation

• Contactinformationofyoursupportgroupandothertrustedfriends/familymembers

• Otherhealthproblemsandmedications youtake

• Allergiesandmedicationsyoucannottake

• YourinsuranceorMedicaidinformationandthehospitalwhereyouprefertobetreated

• Thingsthatmighttriggeranepisode,such aslifeevents,travel,physicalillness,or workstress

• Warningsignssuchastalkingveryfast,paranoia,lackofsleep,sloweddownmovement,excessivealcohol,ordruguse

• Thingspeoplecansaythatwillhelpcalmorreassureyou

• Thingspeopleshoulddoforyousuchastakeawayyourcarkeysandlockupanythingyoucouldusetohurtyourself

• Thingsemergencystaffcandoforyou,suchasexplainthings,talkslowly,giveyouspace,orwritethingsdownforyou

• Reasonsyourlifeisworthwhileandyourrecoveryisimportant

Aworksheetforcreatingacrisisplanisavailableat www.dBsalliance.org/toolBox.

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For Friends and Family Members Oftentimes,friendsandfamilymembershavequestionsabouttheirlovedone’streatment.Hereissomeinformationtokeepinmind.

Theremaybeprivacyregulationsatthehospitalthatwillkeepyoufromfindingoutaboutyourlovedone’streatment.Theserulesaretheretoprotectyourlovedone,nottokeepyouout.Askhospitalstaffwhatyoucandotofindoutmore.Yourlovedonemaybeabletoaskthattherestrictionsberemoved.

Therewillprobablybeseveralprofessionalstreatingyourlovedone.Thismayincludeapsychiatrist,therapist,socialworker,psychiatricnurseandpsychiatrictechnician.Itmaybedifficulttoreachhospitalstaffwhocangiveyouinformationaboutyourlovedone,especiallyatthebeginningoftreatment.Youmayneedtotryseveraltimesbeforeyoureachsomeonewhocanhelpyou.Keeptrying.

Writedownthenameofyourlovedone’spsychiatrist,therapist,andotherhospitalstaffthatworkwithyourlovedone,aswellasthebesttimetoreachthemwithquestions.Writedownthequestionsyouhaveandtheanswersyouaregiven.Keepquestionsspecificandtothepoint.Bepatient,politeandassertive.Askforclarificationofthingsyoudonotunderstand.

Keeparecordofyourcommunicationswithhospitalstaff,includingthetimesofcalls,whoyoutalktoandwhatyoufindout.Ifthestaffisnotresponding,trycallingthehospitalombudsman(patientadvocate)oradministrator.Ifpossible,scheduleameetingforyou,yourlovedone,otherfamilymembers,andhospitalstafftotalkabouttreatmentandotherconcerns.

Beforeyourlovedoneisreleased,makesuretherearewritteninstructionsfortreatment,e.g.,whatmedicationsshouldbetakenandwhen,whotoseeforfollow-upcareandwhen,andwhatprofessionalsareavailableincaseofemergency.Writedownanychangesindietoractivitythatareneededbecauseoftreatmentandaskyourlovedonehowyoucanhelpthem.

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For More information depression and Bipolar support alliance (800)826-3632•www.DBSAlliance.org

dBsa Wellness toolbox www.DBSAlliance.org/Toolbox

dBsa Wellness tracker www.FacingUs.org/Tracker

Bazelon Center for Mental Health law Provides information but does not give individual legal advice. (202)467-5730•www.bazelon.org

national association of protection and advocacy (202)408-9514•www.napas.org

treatment advocacy Center Explains each state’s hospitalization laws(703)294-6001•www.treatmentadvocacycenter.org

Being hospitalized was one of the scariest things I ever did, but looking back on it now, I believe

it was really what I needed. I not only needed medication and a safe place, but I needed some intensive

therapy, some ideas of ways to release some feelings, and I needed

a chance to figure out what my next steps would be when I was

released. I still use things they taught me there every day.

—Nicole

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We’ve been there.We can help.

the depression and Bipolar support alliance (dBsa)istheleadingpeer-directednationalorganizationfocusingonthetwomostprevalentmentalhealthconditions,depressionandbipolardisorder,whichaffectmorethan21millionAmericans,accountfor90%ofthenation’ssuicideseveryyear,andcost$23billioninlostworkdaysandotherworkplacelosses.

DBSA’speer-based,wellness-oriented,andempoweringservicesandresourcesareavailablewhenpeopleneedthem,wheretheyneedthem,andhowtheyneedtoreceivethem—online24/7,inlocalsupportgroups,inaudioandvideocasts,orinprintedmaterialsdistributedbyDBSA,ourchapters,andmentalhealthcarefacilitiesacrossAmerica.

Throughourextensiveonlineandprintresourcesand ournearly650supportgroupsandmorethan250chapters,DBSAreachesmillionsofpeopleeachyearwithin-personandonlinepeersupport;current,readilyunderstandableinformationaboutdepressionandbipolardisorder;andempoweringtoolsfocusedonanintegratedapproach towellness.

©2018DepressionandBipolarSupportAlliance Modelsusedforillustrativepurposesonly

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depression and Bipolar support alliance 55E.JacksonBlvd.,Suite490 Chicago,IL60604 Phone:(800)826-3632or(312)642-0049 Fax:(312)642-7243 dBsalliance.org

Visit our website for important information, resources, chapter connections, to get involved with advocacy, and more.

Wehopeyoufoundtheinformationinthisbrochurehelpful.IfyouwouldliketosupportDBSA’smission,pleaseconsidermakingadonationbycalling (800)826-3632orbyvisitingdBsalliance.org/donate.

ThisbrochurewasreviewedbyDBSAScientificAdvisoryBoardMember,GregorySimon,MD,MPHSeniorInvestigatoratGroupHealthResearchInstituteinSeattle,WA.

DBSAdoesnotendorseorrecommendtheuseofanyspecifictreatmentormedicationformooddisorders.Foradviceaboutspecifictreatmentormedication,patientsshouldconsulttheirphysiciansand/ormentalhealthprofessionals.