Psychiatric hospitals: admission to discharge

Since I can’t sleep and I am in hospital again for the 8th time in 3 years, I thought I’d talk about how the process works and the care you you receive from admission to discharge. As always, I can only go from my experience of the 2 hospitals I’ve been in under the Dudley and Walsall Mental Health trust (DWMH).

Admission

When you first get to hospital a nurse or HCA will show you around the ward, if it’s your first time, and show you to your room. Your bags will be checked for any contraband and chargers will be taken off you and put away for you to ask the staff to use. Chargers aren’t allowed in bedrooms.

A nurse will then go through a set of questions with you. These range from contact details and next of kin to phobias, allergies, and symptoms you’re experiencing. If you’ve been in that hospital before they may not have to ask you everything as they probably will have your previous notes. You will also be asked to sign a few consent forms including whether or not your next of kin can be given information about you, an agreement not to take pictures or videos on the ward and a form which says the hospital aren’t liable if you lose anything.

A doctor will then assess you with the nurse (or student nurse) present. You may have to wait for several hours before you see a doctor, especially if you get admitted during the night, as the duty doctor will have to see patients in A&E, the crisis team and all wards of the psychiatric hospital if they need assessing/admitting. When the doctor sees you, they will run through questions with you again, some of which are very repetitive. Depending on how you were referred to hospital depends on how much detail they’ll need. They’ll ask questions about your history, family history, employment, convictions, drug and alcohol use, what brought you into hospital, delusions/hallucinations, medication, ect. They’ll also assess your risk and decide on what level of observation you need.

  • Level 1/general obs – hourly observations
  • Level 2 – every 15 minutes
  • Level 3 – 1 to 1 or 2 to 1, within eye contact
  • Level 4 – 1 to 1 or 2 to 1, within arms distance

Yes, level 3 and 4 obs are at all times, including showering, sleeping and going to the toilet.

You will also have your physical obs taken, including weight, height, blood pressure, sats, temperature and blood sugar.

After Admission

Usually, you will see a doctor the next day (unless you’re out of area, then it could be a few days). The doctor will go through things such as medication, how you’re feeling/risk assessment and leave. You only have about 10-15 minutes with the doctor, so it’s easy to forget things you want to bring up. My advice is to write everything down and give it to the doctor to read. This saves time and can prompt their questions.

You should also get told who your named nurse is. In DWMH, the aim is to see your named nurse twice a week (although this may not always be possible) to go through your care plan, risk management, how you’re feeling and your rights as an informal (voluntary)/sectioned patient. I’ve had varied experiences with named nurses. I once had one who was amazing and talked to me for an hour and a half about how I was feeling and I’ve also had one who said to me ‘I’m not gonna ask how you are, I’m just gonna fill in this questionnaire’. It really depends on the nurse and their approach. I personally preferred the first one.

FUN FACT! You also have a right to change your doctor and your named nurse. I’m currently in the process of trying to change my named nurse for various reasons (mainly because she’s rude, I can’t stand her and she made me be out to be a liar when I got admitted on Tuesday). I’m not sure if there’s a formal way of doing this but I asked the nurse in charge this afternoon if I could change my named nurse and she said she’ll look into it for me, although she couldn’t guarantee anything.

To change your doctor, you have to write a letter requesting a change, stating the reasons why and then you will be assigned a different doctor. This could take some time though and you may be discharged before this happens.

Life on the ward

It can be pretty dull on the ward most of the time. In most hospitals (unless they’re private), you won’t have a TV in your room. You’re not allowed your chargers so if your phone goes dead, you have to wait for it to be charged in a cupboard/locker room/office. There’s only 1 or 2 TVs on the ward so you have to deal with what everyone else wants to watch/listen to (people like to hide the remote) and it gets turned off at midnight anyway. The only things to do are talk to the other patients, go in the activity room (which is awful at Dorothy Pattison) or smoke (which has been banned in most trusts, except DWMH, but that’s a whole other post I have drafted). The staff try and discourage you from making friends on the ward, which I can kinda understand but you often get more support from the other patients than you do from the staff.

The staff on the ward from day to day are HCAs, nurses and sometimes (or every day at Bushey Fields) an activity worker/occupational therapist/both. If you need to speak to a member of staff, HCAs are more readily available, but just grab a member of staff you feel comfortable talking to you and they’ll (usually) come to you when they’re free.

You will see your doctor once (or in my case, twice) a week. This is called a ward round/review. I’ve also seen in be called a multidisciplinary team (MDT) meeting. You will have your main consultant and then a team of other doctors who are underneath them who will see you (although not necessarily all of them at the same time). A nurse from the ward is always present to take notes. Other people who might be in there are student nurses, student doctors and your CPN/support worker/social worker/psychologist. I’ve also known a girl whose midwife would attend her reviews. You have every right to kick most the people out of your review, other than your consultant/doctor who is leading the review and the nurse taking the notes. If you’re in a hospital out of area but in the same trust, your doctor may not see you as regularly. I have no idea what happens if you’re out of area in a different trust.

Leave

If you are informal, you are free to come and go as you please, under the nurse in charge’s discretion (unless your doctor has said otherwise). If you are deemed as a risk, you either won’t be allowed out or will be allowed escorted leave, usually with a member of staff.

If you are sectioned, you will only be allowed out if you have section 17 leave granted by your doctor. This will outline how long you’re allowed out and who with. If you abscond and don’t return within the specified time frame, the police will be called and you will be brought back to hospital.

If you are an informal patient, you can still be sectioned. This has happened to me 3 times (4 if you include the time I was in general hospital). The reasons for this happening to me are insiting on leaving when there is an imminent risk, and refusal of medication. If you fall under the first reason, you will be put on a section 5(2) by a doctor (or 5(4) by a nurse, then a 5(2) by a doctor) until you either have a mental health act assesment or the doctor lifts the section. If you refuse your medication and it is felt you need it, you will probably have a mental health act assessment to see if you need sectioning or if you can stay informal.

Discharge

Eventually there will come a point when you are ready to be discharged. For me, this has usually been after a week of home leave. You tend to get discharged before you’re better and instead get discharged when the crisis is over, because they need the beds. If you are sectioned, you need to be taken off your section before you are dicharged. If you have been on section 3 (or other various sections to do with the police and court), you might be put on a community treatment order (CTO). This outlines things like where you can live or having to comply with medication and if you don’t, you can get recalled to hospital. I don’t really know much about this, other than what I’ve researched, because I’ve never been on a CTO.


This has all been from my personal experience. If you have had any different experiences then drop me a message or comment down below. I’m intrigued to see how it works in other parts of the country/UK/world.

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