THE EMERGENCY ROOM
Going to the ER can be a way to stay safe during a mental health crisis, and/or a way to fast track access to mental health care.
I know this, because every time I visit my psychiatrist, she gives me a print-out that includes the directive: if you are experiencing a mental health crisis, go to the ER.
It occurred to me: I have no idea what would actually happen at the ER, were I go go there for a mental health crisis. So I asked my dad (a retired ER nurse) how his hospital handled things when someone came in with psychiatric concerns. I also did some reading on local hospital websites. It turns out different ERs have different policies and procedures when it comes to mental health crises, so it is tough to generalize about how the experience might unfurl. But here are the (professionally uncertified) results of my research.
*It is a good idea to bring a trusted person to accompany you to be your advocate. It can also be helpful if you bring in the medication that you are currently taking, as well as the contact info for your doctor, therapist, and/or psychiatrist. (But don't worry about this stuff if the crisis is severe--just get there.)
*When you arrive, a nurse will probably check in with you to assess your situation. They might ask you about your current symptoms and your mental health history. They will probably also ask if you have a therapist or psychiatrist, so that they can coordinate with your current providers.
*Usually, an on-call psychiatrist or a crisis care team is called in to further assess your situation.
*They might offer medication to provide immediate relief or do some crisis counseling. They may also do a physical exam.
*If the experts judge that you are at risk of hurting yourself or others, or if they think you are in need of close observation as you adjust to new meds, they may check you into, or encourage you to check yourself into, an inpatient mental health facility. If the hospital doesn't have a psychiatric wing, they may transfer you to a different hospital.
*If they judge that you do not need inpatient care, they may arrange for you to do an Intensive Outpatient Program or a Partial Hospitalization Program. In an Intensive Outpatient Program, you commute to a treatment facility during the daytime. (Sometimes IOPs are also offered online, or in the evening.) They may also connect you with a community behavioral health program.
*For less severe cases, the psychiatrist or crisis care team may arrange for you to see a therapist or psychiatrist outside the hospital, then discharge you (let you go from the hospital).
My dad was an ER nurse for forty years. He grimaced at everyone. But he was highly competent. He administered medication to many people in psychiatric crises and witnessed profound and immediate transformations. (Granted, I'm pretty sure he was injecting people with Haldol.) At the very least, the people in the ER will help you stay safe until you get some relief from your mental pain. (You don’t have to worry about getting a grimacing nurse, because my dad is retired.)
Most importantly: I am sorry that you are going through such a rough time. Know that this terrible episode in your life will pass, and you will look back on it, and be so grateful that you got help.
(And again, this isn't how things will play out at all ERs. It is just an example of how things can go. Did I mention that I am not a doctor? I am not a doctor. I still care about you, though.)
Here is the suicide hotline again: 800-273-8255
And here are some additional excellent hotlines.
Hang in there. The world needs you.