Going to the Hospital Emergency Room for a Psychiatric Emergency

Important things that you should know about the Emergency Room

  • Services are free, confidential and based on your needs.
  • Hospital staff provide support, problem solve and help manage crisis situations. Above all, they work to keep you safe and help you better manage your situation.
  • Whenever possible, the ER staff tries to avoid hospitalization.
  • Support is generally limited to one visit with referrals often given to other community resources.

Talking about the ER… the realities

    The Wait
    The ER can seem like an overwhelming place. Often there are long waits which can be distressing and frustrating.

    You’ll talk to nurses, the ER physician and possibly, but not always, the psychiatry team.

    A crisis nurse may be there to talk to, especially in the evenings.

  • Interview Rooms
    Interview rooms in the ER are sometimes described as being “institutional” and not very comfortable. Keeping you safe is one goal in the ER. These interview rooms have been designed to manage any situation, such as a person who is out of control for different reasons. You will see security guards in the emergency department too. They are there for the safety of the patients and the staff.

    You can check with your nurse about where to use the phone, or the vending machines.

    The Assessment Process
    To identify the important facts of your situation, questions will focus on the crisis happening now. Nurses will ask questions about your mood, sleep patterns, appetite, psychiatric history, medications, substance use, family history of mental illness, stressors/supports, past history/childhood factors, and legal involvement. Questions about thoughts or attempts of suicide, hurting yourself or hurting others will also be asked.
  • A Plan of Care
    Once you have been seen by the doctor, a “plan of care” is set up. This is simply the formal and informal strategies worked out by you and the staff, for keeping you safe and for supporting your recovery. The plan might include an appointment for further assessment in a community setting. Hospitalization is usually avoided, unless necessary for safety reasons or for the treatment of severe symptoms.
  • Medications
    You may be given medication in the ER to calm anxiety or panic, to help with sleep, or to help clear confused thoughts. These medications are usually fast-acting and intended to help the immediate symptoms. You may take the medication while in the ER or you may be given a prescription to take to a pharmacy as soon as possible.

    Medications for longer-term treatment (e.g. medications to treat mood disorders) are not usually prescribed by Emergency Room doctors because the ER doctor cannot monitor and assess how the medication is working over time. If you need this kind of monitoring, the ER doctor will tell you to see your family doctor as soon as possible. The ER doctor may make an appointment for you to see a psychiatrist as an outpatient to assess and monitor your need for medication.

  • Follow-up
    You may be offered a follow up appointment at a Crisis Service where you can work on crisis planning and explore how to get through tough times. There are a lot of great community resources that can be discussed at that time also.

    You can always call the crisis service yourself to ask for a follow up appointment if you are not offered one while in the ER.

Hospital admission…Voluntary or Involuntary Admissions and “Form 1”

The psychiatry team decides who is admitted for an in-patient stay. If they think you may benefit from admission and you are in agreement then you are considered a “voluntary patient”.

Involuntary status is a special situation where a doctor can decide for specific, detailed reasons that you should be hospitalized even if you don’t agree. A Form 1 is a legal document that explains the doctor’s reasons for admitting you, and is valid for 72 hours.

A Form 1 is a way to keep you safe and help you gain some control of your situation during that 72 hours, despite what can feel like a loss of control.

All patients have legal rights. If you are an involuntary patient you have access to Patients’ Rights Advocate to help you understand the legal details of what is happening.

The most important thing about coming for help

The decision to come to ER can be very overwhelming and frustrating. That is the bad news. The good news is that with their help, you can get better. You will get better. You will get unstuck. You will gain control through increased understanding, more coping tools, and the knowledge that you are not alone. There are people there for you, people trained to make a difference. Going to the ER is not an easy step, but it can be your first step to regaining control of your life.

Information provided by www.mindyourmind.ca
www.mindyourmind.ca thanks Dr. Margaret DeCorte, Ph. D., C. Psych. and her youth crew at Royal Ottawa Hospital, Ottawa, ON