A lot of people don’t realize, but there is a psych section of most emergency rooms. People aren’t automatically sent straight up to the psych ward. They have to be evaluated first. I’m a psychiatric social worker in the emergency room of a large hospital, and I’ve seen it all. This is what happens if you come to the hospital with a psychological emergency.
The psych ER is a locked facility. When you arrive, you have to change into paper scrubs, and all your belongings are put into a locker. This includes your cell phone. So many people are triggered into anger or despair based on text messages they receive. We want to assure that you remain as calm as possible. The psych ER is different than the rest of the emergency room. There are no machines or monitors; there are no TVs. We want to assure that there is nothing in a room that a patient can use to hurt himself or others. We don’t want a patient to die by suicide when we’re trying to help them.
The patient has to be assessed by a nurse, medical doctor, social worker (psychotherapist) and psychiatrist. Each has a specific role in the evaluation of the patient. The staff work together as a team to decide if the patient is a danger to himself or others, if the patient is safe to go home, and what outpatient services the patient may need. It’s not a fast process, there are a lot of people and steps involved. Don’t expect to go home quickly. You’ll be here a while. Most importantly, you cannot sign yourself out of the psych ER against medical orders. You just can’t. It is within the law to keep you in the hospital until you are deemed safe to return to the general population. This is for your safety and the safety of others. Be prepared to stay for a few hours.
There are many types of people that end up in the psych ER. There are psychotic patients. These are the ones that can be the most interesting. They may think they are a queen, or run for president, or travel the world in a hot air balloon. These are the stories that you just can’t make up. They blow your mind and, although you feel sorry for the person and genuinely want to help them, sometimes you just have to laugh. Please don’t take it personally when staff in the psych ER laugh. We see so many traumatic cases, sometimes laughter is the only way we can stay sane ourselves. We are never laughing at you, we may just find your delusion particularly interesting.
There are the patients that are hallucinating (also psychotic). They often see devils, shadow people, or even a moose in a parking lot. Many of the patients know that their hallucinations aren’t real. Some think they are. They may have auditory hallucinations, too. These can also vary from old baseball news reports on the radio to voices telling them to kill themselves or others. Sometimes these are original and amusing. Sometimes they are just scary. These patients may be helped with a slight adjustment to their medication, or may need inpatient admission to stabilize them.
There are patients with behavioral problems. The ones that live in group homes and may have low IQs and just act out when frustrated. They usually mean well, they just don’t know how to regulate their emotions. There are those with PTSD or a history of being abused. Some of these self-harm because they don’t know how else to cope. They are fairly stable, they just need some guidance and emotional support. They need outpatient resources to help them learn to cope better with daily life. The danger with these patients is that they may accidentally hurt themselves or others. But with the right supports they should be safe to return home.
Then there are homicidal and suicidal patients. The homicidal patients are almost always admitted to the psych ward. They require immediate stabilization and we have a legal duty to warn their intended target (although usually it’s just a general feeling they have, not aimed at anyone in particular). The suicidal patients are the ones that break your heart. The usually have suffered some traumatic event or some great loss. They have given up the will to live. Some have the insight to come to the hospital before they do anything drastic. Sometimes they can go home and see an outpatient therapist and psychiatrist. Most of the time they come to us after they have attempted suicide. There is such a myriad of ways to attempt suicide, I had no idea before I started working here. The people who attempt suicide are always admitted, often involuntarily, to a psych ward.
The psych ward is actually a nice place to stay. It’s not scary, dark and dingy, like in the movies. It actually resembles a mid level hotel, like a Hampton Inn. Patients have their own room with a real bed. They can order their food off a menu. They have activities such as therapeutic painting classes. And, of course, medication maintenance. Yes, we can involuntarily commit you. We can require that you stay long enough to get well. This is to ensure your health and safety, we don’t get any benefit in keeping you longer. In fact, most modern psych ward stays last less than one week. And the primary purpose is always to help the patient recover enough to no longer be a danger to himself or others, no matter how long that takes.
The people who come to the psych ER vary so much; we see people from every demographic. We see people from every ethnicity, we see children as young as 4 years old to people in their 80s. We see homeless people and wealthy people. We see drug addicts and health nuts. We see mechanics, rocket scientists, and fast food workers. I always explain that we are all one step away from ending up in the psych ER. If we are the victim of a violent crime, a family member has been murdered, a national tragedy such as 9-11, we can suffer the psychological effects so severely that we require intensive medical help. An effective team never thinks of ourselves as different from our patients. They are mothers, sons, brothers, cousins. They are us, in a different situation. An effective team sees every person as an individual who has suffered some tragedy that requires them to get special medical attention. Their illness is no different from any other medical illness, it just remains an “invisible illness” that cannot be measured on paper. But our sole purpose, in the psych ER is to help our patients return to enjoying their lives, return to happiness, return to peace and contentment. We want them to live normal, comfortable lives. We’re here to help.
If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline. Outside of the U.S., please visit the International Association for Suicide Prevention for a database of resources.