In the finale to my series about “Questions People Are Afraid to Ask About Mental Illness” I want to explore a question asked more often by those experiencing an acute psychiatric emergency, and their loved ones.  How do you know when it is time to go to the hospital?

Let me start with a personal story of a recent event.

From Tuesday to Friday afternoon my hypo-mania had been getting more and more pronounced.  I had an appointment with my psychiatrist on Thursday afternoon, and he adjusted my medication to try to bring me down gently.  I was to start that new dose on Friday night so that I could have the weekend to get used to the potential drowsiness.

On Friday, I went after work to the pharmacy to get my prescription filled, then went directly to a craft store.  I was feeling boundlessly energetic and happily talked to myself the whole way to the store.  My reason for going to the craft sotre?  To purchase an xacto knife.  The planned purpose of the xacto knife?  To do an undecided level of harm to myself at a later time, when my mood dropped.  It was all perfectly logical to me at the time.

After going to the craft store, I went to the grocery store to pick up some food for dinner that night, and got on the highway to get home.  Almost as soon as I got on the highway, my mood took a strong drop.  I became very panicked about what I was going to do to myself.  I could not see a future no matter how hard I looked.  I called my therapist who used some mindfulness techniques to help me calm down.  She encouraged me to throw the xacto knife out the window, but I didn’t want to.  I was worried I would throw it out the window, someone would find it, and use it as a weapon; and then my fingerprints and DNA would be on it and I would be blamed for the crime.  Illogical now, but at the time, perfectly logical.

After speaking with my therapist I was supposed to go to a bookstore until I could get a hold of my husband and be sure he was home.  Instead I decided that what I needed was to increase my mood, so I went to a convenience store and purchased an energy drink.  From there I went home.

Once home I gave myself a few superficial cuts before once again panicking and calling my husband.  He was almost home and had me stay on the phone with him until he walked through the front door.  As the night progressed, my mood stayed low and my thoughts were of a self-harm nature.  My husband and I briefly discussed me going to an ER for observation and a potential longer stay, but we did not like the idea of me being in a hospital for around 8 days, which is immediately where our thoughts went.

I eventually called my psychiatrist and explained what was happening.  He told me to go to the ER.  I stayed there for 16 hours, and was discharged feeling much better.  The lack of stimulation in the psychiatric emergency side of the ER, along with my medications and a kind hospital staff helped to re-center me.  My husband stayed with me the entire time, for which I am very grateful.

Looking back, I see that I should have gone in sooner.  I should not have avoided going, because they will only keep you as long as you need it.  Just because you enter an ER in a psychiatric crisis, does not mean that you will be leaving in an ambulance on your way to a behavioral health hospital.

Since getting home, I realize that I should have gone when the crisis began, and maybe it wouldn’t have gotten as bad as it did.

So, when should you go to the hospital for a psychiatric crisis?  When you become a danger to yourself or others.  I was a clear danger to myself, but felt I should be able to control it.  I felt guilty for putting my husband though a potential long hospitalization, and I was worried about what it would mean for work.  What I should have focused on was that it would be worse for my husband and for work if I had stayed out and done real damage to myself.

No one wants to go to a hospital, but when it is between that or being a real danger, a visit to the hospital is needed.

I want to send a great big thank you to:

My husband

My psychiatrist

My therapist

All of the kind and caring hospital staff out there