Navigating and Understanding the Adult Inpatient Hospital System

Many people find the process of psychiatric inpatient hospitalization frustrating and confusing. This document explains the process of admission to a psychiatric acute inpatient hospital and provides tips to help make a hospitalization a bridge to long term recovery. The information provided below applies only to adults at least 18 years old.

This page includes:

Preparing for a Crisis
Voluntary and Involuntary Commitment to Inpatient Hospitalization
Types of Inpatient Hospitals
Locating a Loved One Admitted to a Psychiatric Hospital
Care Providers in the Inpatient Hospital Setting
How to Contact Care Providers
Information the Inpatient Team Will Need
Family Meetings
Discharge Planning
Patient Rights

Preparing for a Crisis

It is easier to respond quickly and appropriately to a crisis if you have identified your local resources before a crisis. Take some time before a crisis develops, to identify the nearest emergency room that has mental health professionals on-site. Consider calling the local police department to notify the department that your loved one has a mental illness. For additional advice, see https://namimainlinepa.org/resources-for-coping-with-preparing-for-and-preventing-a-crisis/.

Voluntary and Involuntary Commitment to Inpatient Hospitalization

For a quick overview of the procedures for voluntary and involuntary commitment, see http://mces.org/pages/crisisint_faq.php. For a more detailed explanation, see https://namimainlinepa.org/voluntary-and-involuntary-commitment-to-inpatient-hospitalization/.

Types of Inpatient Hospitals

Acute inpatient psychiatric units are locked psychiatric units that treat people who are struggling with depression, mania, psychosis, self-harm, and suicide as well as other psychiatric conditions. People can be admitted to these units voluntarily or involuntarily. The units are locked for the safety of the people being treated on these units.

Dual diagnosis units are a type of acute inpatient psychiatric unit. They are locked and they treat people who are struggling with BOTH addiction and depression, mania, psychosis, etc. These units have a lot of experience treating drug and alcohol withdrawal symptoms and may have therapeutic groups that focus on addiction. Some of these units are also able to treat people who do not struggle with addiction.

Inpatient detoxification and rehabilitation (detox and rehab) units are NOT locked. People can only go to these units voluntarily. These units are intended for people primarily struggling with addictions. The groups on the unit focus on addiction and the staff is experienced in managing withdrawal symptoms.

Subacute inpatient hospitalization consists of treatment at a facility that may be unlocked. People can only go there voluntarily. This type of hospitalization is often useful when an issue at a person’s residence is contributing to the person’s worsening symptoms but there is NOT an acute safety concern.  Some insurance plans do NOT cover subacute inpatient hospitalization.

Locating a Loved One Admitted to a Psychiatric Hospital

When a person is hospitalized, the family is often NOT notified of where a person has been hospitalized. In Philadelphia, a 302 petitioner can call the CRC that evaluated the patient and obtain information on where the patient was hospitalized. All psychiatric units have phones that are available to patients for use if the patient wishes to contact family. Alternatively, one can call area psychiatric hospitals. The psychiatric hospital staff will likely state that it cannot confirm that the person is admitted to the hospital. A family member can request that his/her contact information be provided to the treatment team if the person is admitted to that hospital. A family member can also request that his/her contact information be provided to the patient so the patient can call.

Care Providers in the Inpatient Hospital Setting

Attending physicians/attending psychiatrists are the doctors who supervise the resident physicians and medical students. The attending physician makes the final treatment decisions. The attending physician may be on the unit for only a few hours each day. He/she sees the patients each day and then discusses the plan with the resident physicians and medical students. Some hospitals only have attending psychiatrists and do not have medical students or resident physicians.

Resident physicians/psychiatrists are doctors who have completed medical school and are now training in psychiatry. The “resident” physician is training in a specific area of medicine (for example: psychiatry) under the supervision of more experienced physicians (“attendings”). The resident physician is on the unit most of the day and is usually the doctor who calls patient’s families and outpatient doctors.

Medical students are people who are in medical school and may or may not go into the field of psychiatry. They often have more time than the attending and resident to have longer conversations with families. If families provide information to the students, the students will pass that information along to the resident and attending.

Nurse practitioners and Physician assistants are mental health providers who are supervised by a psychiatrist.

Nurses are on the unit 24hrs a day and they are a wonderful resource. The nurses can provide information about how a patient is doing and the name of the doctor caring for the patient. They can also notify the doctor that a family member called and would like to speak with the doctor.

Therapists are often on the unit throughout most of the day and facilitate both individual and group therapy sessions.  They can be a valuable resource to patients, as well as their family members and the rest of the treatment team by helping patients to learn coping skills to better manage symptoms and stress upon discharge from the hospital.

Social workers are available on all acute inpatient psychiatric units. They play a very important role in determining what resources the patient will need upon discharge. They may assist patients in obtaining housing (for example: boarding homes, shelters). They can submit applications for case management services, partial hospital programs, extended acute care, and many other services. The services they can obtain for any individual are limited by insurance and eligibility criteria.

How to Contact Care Providers

The Health Insurance Portability and Accountability Act (HIPAA) and state and local mental health laws limit the mental health treatment information that can be released to families without the patient’s consent. The law does NOT prohibit treatment providers from receiving information from families.

Unfortunately, it can be difficult to provide information to hospital staff because the hospital will not acknowledge that a person is admitted without consent from the patient to release this information. To share information in this circumstance, you can go on the hospital’s website to locate a relevant fax number or email address and send your information that way. You can also mail information (though this method may be too slow to be helpful). Hopefully, the hospital will get the information to the appropriate provider.

The main hospital operator can give you the nursing station number (unless the patient requested that this information not be shared). You can then call the nurse’s station and request the name of the patient’s provider and request that the provider call you. Weekdays, during business hours, are the best times to call to speak with a mental health provider. There is always a mental health provider available to patients 24 hours a day, but the provider available on the weekends and overnight is responsible for many more patients than the daytime providers. The overnight/weekend provider is also not the provider making the most important decisions about treatment and discharge. 

Medical students and resident physicians are great resources for families and patients. If you have concerns that the medical students and residents cannot answer, you can always ask to speak with the attending physician.

Information the Inpatient Team Will Need

Individuals may not be able to provide an accurate history when they are in crisis. It is very helpful when families can provide information about what medications the hospitalized person was prescribed at the time of the hospitalization, and the medications the person has been on in the past and why they were stopped (side effects, did not help). It is also very helpful when families can provide information about medical history, allergies, substance abuse, the stressors that may have contributed to the crisis, contact information for the person’s outpatient psychiatrist, and any history of violence, threats of violence, self-harm, and/or suicide attempts.

Family Meeting

During the first few days of a hospitalization, the best way to communicate with the inpatient team is usually the phone. People who have recently been admitted are sometimes too ill to have a meeting with their inpatient team and family in order to plan for the future. But it is useful to notify the team early in the hospitalization that the family would like to have a family meeting when the patient is more stable.  

As an individual begins to recover and to prepare for discharge, it can often be helpful for the patient, family and treatment team to meet and discuss the plan for treatment and housing upon discharge. Family members (or any support person) can ask the treatment team for a family meeting. It is rare for this request to be denied but it is important to note that the hospitalized person needs to consent to the meeting.

Discharge Planning

Acute inpatient hospitalizations are often short. In most cases, individuals are discharged when the treatment team believes the patient is safe for outpatient treatment. There are many different types of outpatient treatment including but not limited to partial hospital programs, intensive outpatient programs, assertive community treatment, case management, treatment by a psychiatrist and therapist, and treatment by a psychiatrist only.  To learn more about the outpatient treatment options available in Southeastern Pennsylvania, see the Introduction to Services at https://namimainlinepa.org/services-in-sepa-2/intro-to-services/.

The patient will likely still have symptoms at the time of discharge. Family involvement is very important during discharge planning. Family members know a lot about how the hospitalized individual functions outside of the hospital and how much support the person may need on discharge.

It is important to talk with the inpatient team before discharge to ensure that the patient and a support person understand the medications prescribed at discharge and where the patient will be getting treatment after discharge. It may be helpful to have a family member or support person pick the patient up from the hospital. At that time, the nurse will provide written instructions for follow up and a list of medications. If the patient and/or support person have any questions that cannot be answered by the nurse, they can ask to speak with the doctor.

Discharge planning is often the most important part of a hospitalization because changes (for example, changes in medication) that were made during the hospitalization and found to be helpful, will have to be continued by the patient, support persons, and outpatient providers after discharge in order to maintain stability and increase the likelihood of continued improvement.

Patient Rights

The rights granted to patients under Pennsylvania law are described at http://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/055/chapter5100/s5100.53.html&d=reduce.

Page last updated in August 2020.