Tuesday, November 22, 2011
DO YOUR RESEARCH BEFOREHAND!
As a person with DID I have been hospitalized 5 times related to DID issues. I decided that I should talk about what to expect when you are hospitalized. It is not unusual to expect that at some point in your life you may need to go into the hospital. While I have had fairly decent hospital stays, (except for the latter which was due to the lack of organization of the staff) I do know that it is in your best interest to look into hospital options in your area. Research this on a day when you are feeling okay and write down the information you find out and keep it handy. What are some of the things you should for in a good mental health ward in the hospital?
1. Ask about the unit and the leadership that is placed on the unit. Who runs the ward? What is their approach in treating DID? What is the staff-to-patient ratio? Are there mainly techs on staff or are their plenty of nurses and qualified psychologists on hand?
2. Research the policies and procedures regarding restraints and seclusion. I would like to note here that this is ALWAYS a last resort option, to keep someone who is out of control and a threat to themselves and other patients. I have never personally in all 5 hospital stays witnessed this happen. So don't let that frighten you. It is just important you know there standards on this issue.
3. Find out if they offer any services for significant others and family members. Most wards do offer a family group at least once a week to help educate everyone as a whole.
WHEN IS IT TIME TO THINK OF GOING INTO THE HOPSITAL?
It's time to consider going when:
· You are having unmanageable flashbacks
· You feel unsafe ie; doing self injury, contemplating suicide
· You are feeling over-whelmed and confused
· You feel out of control or are a threat to others
Before making the decision it is a good idea to call your therapist, who can help guide you in making the decision and also help get the process rolling. If the situation is dire and you need help immediately go directly to the emergency room. Do not attempt to drive yourself. Have a friend, family member, neighbor drive you or call 911.
WHAT TO TAKE TO THE ADMISSIONS OFFICE
· Any previous medical, psychiatric, psychological reports. IF you have copies, if not have the phone numbers available so the hospital can get the information faxed over)
· Your insurance card.
· Social security card of the person responsible for the bill.
· Name and address of an emergency contact person.
· A checkbook or credit card in case the hospital required a deposit. They rarely do but it is better to be on the safe side.
WHAT TO PACK IN YOUR SUITCASE
· A weeks worth of underwear items
· A weeks worth of socks
· Pajamas (unless, you love the gowns they give you!)
· 1 Bathrobe
· A weeks worth of comfortable shirts, with no profanity, alcohol ads, and so on
· 1 sweater, as the wards seem to be cold (probably to keep us awake from all the meds! LOL!)
· 4 pairs of pants or jeans
· 1 pair of slippers (the ones they give you, otherwise, are horrendous)
· 1 pair of shoes, but be forewarned that if there are laces in them they will remove them
· Shampoo and conditioner in plastic containers. (You do not want to use their shampoo, trust me)
· Plastic comb or brush
· Soap (from my experience their soap is awful)
· Toothbrush and toothpaste
· A small amount of change to make phone calls if they do not offer a free ward phone to use
· Comfort items ie; stuffed animal (no ties, or strings on them), coloring books and crayons, family pictures (no glass frames)
Most wards do offer laundry facilities so keep that in mind when packing.
WHAT NOT TO PACK IN YOUR SUITCASE
The hospital staff will go through your things to remove anything they consider "SHARPS". So here is a list of the things to leave at home:
· No glass items, sharp objects, or anything with cords.
· No soda cans, curling irons, hair dryers, lighters, matches, mirrors, glass bottles or razors. Some of this stuff, if you do decide to bring them anyway, will be locked up and you will have to ask the staff to get them for you, and they will usually watch you use the objects.
· No belts
· No plastic bags
· Medications (make a list of meds you currently take and they will order it from the pharmacy to give to you. They do not use the meds you bring so leave them at home.
· Also, leave your cell phone at home or with a friend as you won’t be allowed to use it.
WHAT HAPPENS AFTER ADMISSION
The first thing you should expect, and if it doesn't happen ask for it, is you should receive a Patient's Bill Of Rights. This is VERY important and should be read over carefully!
The following is an example of your rights. I was given permission by Thomas V. Maguire, Ph.D to share this. Thanks Dr. Maguire!
PATIENT'S BILL OF RIGHTS
As a Matter of Personal AUTHORITY,
You Have the Right . . .
· to manage your life according to your own values and judgment.
· to direct your recovery, answerable to no one for your goals, effort, or progress.
· to gather information to make intelligent decisions about your recovery.
· to seek help from a variety of sources, unhindered by demands for exclusivity.
· to decline help from anyone without having to justify the decision.
· to have faith in your powers of self restoration -- and to seek allies who share it.
· to trust allies in healing as much as any adult can trust another, but no more.
· to be afraid and to avoid what frightens you.
· to decide for yourself whether, when, and where to confront your fear.
· to learn by experimenting, that is, to make mistakes.
For the Preservation of Personal BOUNDARIES, You Have the Right . . .
· to be touched only with your permission, and only in ways that are comfortable.
· to choose to speak or remain silent, about any topic or at any moment.
· to choose to accept or decline feedback, suggestions, or interpretations.
· to ask for help in healing, without having to accept help with work, play, or love.
· to challenge any crossing of your boundaries.
· to take appropriate action to end any trespass that does not cease when challenged.
In the Sphere of Personal COMMUNICATION, You Have the Right . . .
· to ask for explanation of communications you do not understand.
· to express a contrary view when you do understand and you disagree.
· to acknowledge your feelings, without having to justify them as assertions of fact or actions affecting
· to ask for changes when your needs are not being met.
· to speak of your experience, with respect for your doubts and uncertainties.
· to resolve doubt without deferring to the views or wishes of anyone.
Specific to the DOMAIN of Psychotherapy, You Have the Right . . .
· to hire a therapist or counselor as coach, not boss, of your recovery.
· to receive expert and faithful assistance in healing from your therapist.
· to be assured that your therapist will refuse to engage in any other relationship with you -- business, social, or sexual -- for life.
· to be secure against revelation of anything you have disclosed to your therapist, unless a court of law commands it.
· to have your therapist's undivided loyalty in relation to any and all perpetrators, abusers, or oppressors.
· to receive informative answers to questions about your condition, your hopes for recovery, the goals and methods of treatment, the therapist's qualifications.
· to have a strong interest by your therapist in your safety, with a readiness to use all legal means to neutralize an imminent threat to your life or someone else's.
· to have your therapist's commitment to you not depend on your "good behavior," unless criminal activity or ongoing threats to safety are involved.
· to know reliably the times of sessions and of your therapist's availability, including, if you so desire, a commitment to work together for a set term.
· to telephone your therapist between regular scheduled sessions, in urgent need, and have the call returned within a reasonable time.
· to be taught skills that lessen risk of re-traumatization: containment (reliable temporal/spatial boundaries for recovery work); systematic relaxation; control of attention and imagery (through trance or other techniques)
· to reasonable physical comfort during sessions.
After this you will be examined and questioned by a nurse and the rules and expectations of the ward will be explained to you. For instance most hospitals make it mandatory to attend all group therapy sessions, unless an order from your Doctor excuses you. The next thing that will happen is you will be assigned a Psychiatrist who will be in charge of your medications through your entire stay. You will see him/her once a day to talk and see if you need any adjustments to your meds or new meds added. You, as a patient, ALWAYS have the right to refuse to take a medication if you feel uncomfortable about it AND you have the right to request a new Psychiatrist if you do not like the one you are assigned to.
You will be shown to your room, given the daily schedule, and a basic orientation of your treatment plan while you are there. It can feel a bit over whelming and even scary but you will find that you will become accustomed fairly quickly to the routines and meeting the other patient's. These wards are not like what they show in the movies. Most are very nice and have lots of activities going on all the time.
A TYPICAL DAY ON A PSYCH WARD
· Rounds with the nurses and Doctor
· Morning group (usually set goals)
· Free time
· One-on-one therapy with your assigned staff member
· Recreation therapy
· Free time
· Educational Group
· Outside time
· Nutritional group
· Work on assignments
· Free time
· Relaxation group
· Free time
· Wrap up group (have you accomplished your daily goal?)
· Free time until lights out (usually 10:00-11:00 week days and 12:00 weekends)
The average hospital stay is 3-5 days, basically once the crisis is settled down. Most insurance companies only authorize 4 days in a psychiatric ward. After that every subsequent visit needs to go before your insurance company review board, to see if your extended days are deemed "medically necessary." Your Doctor may have to fight to keep you in longer but the bottom line is that if you are not unsafe, feeling suicidal then that is considered medically necessary by most insurance companies.
What do you do if you have no insurance? The hospital admissions office may be able to help you get "Catastrophic Medicaid, help arrange a bank loan or negotiate another payment method. Contact a social service worker while you are in and they can help you with this. I personally know of patients who have had their whole hospital bill covered with the help of a social worker!
Just a few cost facts (don't let it scare you) that are outrageous:
· Electrocardiogram (ECG) $175.00
· MRI brain scan $850.00
· Electric shock therapy $5,000.00 (10 treatments)
· Consultation fees $600.00
Therapy fees (rounds) $1,600.00
· psychological testing $400.00
· Medications $300.00
This is why you need to explore your financial options carefully! You can still be helped without losing all your assets.
Partial care or day program is often the best step down from an in-patient hospital stay. It involves spending time in the hospital from 6-8 hours, learning coping skills, recreational therapy and educational groups. The unfortunate part of this program is it is often not covered buy a lot of insurance companies. If your insurance will pay for this option then you should take advantage of it! The idea is to heal, after all. Make the best of your hospital stay whether it be in-patient or out-patient. It is hard work and it is not fun but it is enormously helpful!
While in the hospital you may be offered different medications. I have compiled a list of different meds commonly used in treating DID.
lexapro (escitalopram oxalate)
Edronax, Vestra (reboxetine)
Serzone ( nefazodone)
NON-THERAPEUTIC DOSE ANTI-PSYCHOTIC DRUGS