There may come a time when you feel that it isn’t possible for you to keep your loved one safe at home and they’re mental health has deteriorated to such at an extent that they are danger to themselves or to someone else.

There are two primary routes into an inpatient mental health hospital, voluntarily or through detention under the Mental Health Act. There are also some other option available in some areas of the country such as crisis beds or respite care but these are few and far between.

Treatment once someone is in a mental health hospital (sometimes called ‘being inpatient’ of a Tier 4 service) is almost idential regardless of whether someone is admitted voluntarily or through the Mental Health Act.

Beacuse there is a shortage of Mental Health beds, all places in Mental Health hospitals are managed by NHS England and although ideally patients are sent to a local hospital, it is not the slightest bit unusal for people to be sent anywhere in the country.The NHS regularly purchases beds for patients from private hospitals. This may sound like a ‘posh’ option but the reality is that these hospitals are not of any greater standard or quality than NHS hospitals.

If you find the idea of your loved one being admitted to a mental health hospital frightening, you are not alone.

Brook, A sister

Understand the process

Voluntary admission

If everyone (the patient, their nearest relative and a psychiatrist or duty social worker) agree that your loved one requires hospitalisation, it is possible for a patient to be admitted voluntarily. This does not mean that you can drive up to the door of your local hospital and ask them to admit your loved one. The shortage of beds means that getting your loved one admitted, even when they are suicidal or at significant risk to themselves or others, usually takes a lot of hard work.

The ward or hospital they are admitted to will very likely have patients who are there both voluntarily and those detained under the Mental Health Act so although they can technically leave whenever they like, all the doors will be locked and their movements and possessions restricted, both for their safety and for others.

Tip: If you feel that your loved one needs to be admitted, go the volunatary route first of all. If there is a reluctance to admit under that route, you can then ask for an assessment under the Mental Health Act which involves 2 psychiatrists and an Approved Mental Health Professional (AMHP). Even if you can’t convince people of the need for admission, you are likely to get some decent home treatment or crisis support at home.

Involuntary admission

Otherwise know as Detention under the Mental Health Act or ‘being sectioned’ after various ‘sections’ of the Mental Health Act that describe the length of time and who can detain someone, involuntary admission means someone is held in a Mental Health hospital until it is felt safe for them to be released and so that they can receive treatment.

The process that allows someone to be detained in very complex. This information from Mind explains the process. There is also a great deal of information on the NHS websiteas well as on this page of this website.

If your loved one is sectioned, ask about ‘Aftercare.’ If there is one advantage to someone being sectioned it is that there is a legal requirement for support services to be provided and your loved one should be a priority. There is more information on the Mind website.

What it's like on a Mental Health ward

If you have never been on a Mental Health ward, then you may have all kinds of expectations or concerns about what it will be like for your loved one.

In general, every patient has their own room and often their own ensuite toilet and shower. Most wards aren’t like a traditional ‘ward’ at all. Usually, accommodation for men and women is separate in terms of bedrooms but men and women can socialise together. Children under the age of 18 should always be in separate accommodation and aren’t allowed to mix with adults. There is generally a communal area with tables and chairs, a TV and an area for eating. All the doors are locked between the outside world and the ward. That means that visitors have to be let in and let out. Visitors are not usually allowed in patients bedrooms.

Often there is an outside area where people can smoke or get some fresh air. Children under the age of 18 aren’t allowed to smoke which can cause quite a lot of irritation.

There are rules about what you can take onto the ward (no aerosols or lighters for example) and some of your loved one’s possessions will be kept locked up and can only be used when they are supervised. Sometimes that includes mobile phones and there are very strict rules about not taking photographs.

Some people require 1 to 1 nursing or even occasionally 2 to 1 nursing and during the first 72 hours of admission, people are usually supervised closely.

There are often some interesting ‘characters’ on the ward but the atmosphere is generally one of quiet boredom. Most people sleep a great deal. It can feel quite claustrophobic with all the locked doors.

The food is about what you’d expect from the NHS but patients can order takeaways to be delivered!

Jargon

There is a huge amount of jargon associated with hospitalisation. You can find out more from Mind here.

Children

There are very strict rules about children who are kept inpatient in hospital wards and they should not be housed with adults. In reality, there are nowhere near enough beds for children who need inpatient care so you can expect that your loved one will be sent to a hospital that isn’t very near to home. This can make visiting very difficult and children really do need to see their families so it can be quite distressing.

If your child is sent to a hospital far away from home, ask that they are moved closer as soon as possible. Be aware though, that children’s wards are managed carefully to make sure that the mix of patients works and that new admissions are a good fit for the other people who are there so a move could take some time.

Children under 18 are usually not allowed to smoke whilst they are inpatient which adds another layer of stress to those that are inpatient that previously smoked.

Your child should continue to receive an education whilst in hospital although this is generally only for a couple of hours a day.

This document from NHS England sets out the standards and requirements for inpatient care of children and young people.

Visiting

Some suggestions:

Find out what time ward ‘handover’ is and phone up an hour before each handover to find out how your loved one is doing. Phone twice a day – not only will that make it clear to staff that you are taking a close interest in your loved one’s care but it will also reassure your loved one that you are around, interested and supporting them.

Your loved one will need to permit the ward staff to discuss things with you. If they refuse, still phone up and ask staff to let them know you’ve phoned.

Ask about treatment plans, prognosis and outcomes – sometimes it can feel like there isn’t a lot happening. Things do move slowly and when your loved one is first admitted they are likely to sleep a lot. They’re in hospital because they aren’t well and just like physically unwell people, sleeping aids recovery.

Visit as often as you can. It’s really important that your loved one keeps in contact with the outside world and everything that is happening. Get other people to visit as well – in general, they need to phone up to check it’s ok but so long as your loved one is happy then that’s generally ok with the ward staff.

Take in stuff for your loved one to do or read. Also take comfort items such as chocolate, fruit or bath stuff.

Make sure you get some rest yourself. If you’ve had a difficult few weeks that have led to the person you care for going into hospital, then it’s likely that you and your family are going to be shattered. Take the time to regroup and reflect especially if you think you need to do things differently.

Something keeping you up at night?

You aren’t alone. You may find more information in our section: “The Tough Stuff” – things no-one talks about