Crisis & Urgent Care
Most of the time young people will be treated in the community (you stay at home and just go to services for appointments or therapy.) However, for some people, at certain times it can be better to manage their problems in a hospital environment.
What is hospital like?
A mental health hospital is much like any other hospital. There will be wards, patient rooms, activity rooms, visiting areas and lots of different staff. How many other patients there are and the types of problems they are experiencing will depend on the ward.
I was sent to the hospital. I was in and out of there three times in two years. You get used to it. The first night is always the hardest. Annabel, 17 years
There are two types of hospital stay:
- You can attend as a day patient (where you attend for several hours regularly and go home each day) or
- As an inpatient (where you stay day and night for a certain amount of time).
There are several different types of wards too (see below) and wards for people of different ages (children, young people, adult) but these may vary from area to area.
You are also allowed visitors and there are options to have home leave during your stay. Your time in hospital should only be a small part of your overall treatment so try to see it in this context.
Types of ward:
- Acute wards: when you are first unwell this is usually the first ward you would be admitted to. This is called acute as people are usually quite unwell on this type of ward. You will be assessed here and maybe given treatment.
- Psychiatric Intensive Care Unit (PICU): you may have a stay on a PICU if you are very unwell or if there is a concern about safety to yourself and others. It is a bit more intensive than an acute ward with more staff and support. You could be transferred here from an acute ward, or admitted here directly.
- Rehabilitation ward: if you have been on an acute ward or PICU you may later be transferred to this type of ward to help you become more active and independent ready for discharge. This is where you may start talking therapy, art therapy (creative expression like art, music or dance) or occupational therapy (meaningful activity, learning how to cook, or live more independently).
- Specialist wards: these may be for you if you have a problem that is not suited to a general ward and which needs specialist support, these could be local or regional and include:
- Young person’s unit: if you are young you should be in an age-appropriate environment so it may be that there is a ward for 16-17 year olds and specialist staff that can support you.
- Mother and baby units: if you are unwell during pregnancy and want to have your baby and return to supportive environment / or if you become unwell when baby is very young and he/she can stay in with you. Specialist staff will help support you and your child.
- A forensic ward: if you have a mental health problem and have offended you may be admitted to a forensic ward with specialist staff that can manage risk. There will usually be a female and male ward / hospital and appropriate activity and therapy for you. The level of security will depend on if the ward is low / medium or / high secure.
- An eating disorders ward: specialist staff can help you as a day patient or an inpatient on these wards and treatment may include a personalised diet and activity plan as well as monitoring and medical treatment.
- If you are at risk of serious self-harm or suicide
- If you have serious health complications
- If you are considered to be a risk to other people
- If you have serious self-neglect and cannot look after your own needs
- If you need continuous monitoring for some reason
- If community treatment is unsuitable for some reason
- You can live in the community as normal but if you do not comply with the conditions of your section you can be recalled back to hospital and some people may find this distressing.
- Some people might feel less supported outside of a hospital setting even though there will be staff that can be contacted at all times.
- Some people may not agree with being on a CTO and may want to contest this at a tribunal.
- Informally (you agree to being admitted and go for assessment or treatment there) or
- Formally (under a ‘section’ of the Mental Health Act). The Mental Health Act is the law under which someone can be admitted, detained and treated in hospital against their wishes. This may be the case if a) you are very unwell but do not agree to have treatment but health professionals think that treatment is necessary for your health; or b) you go in informally but then become more unwell and professionals decide it is better for your health to stay for longer. Read more: Rethink 2009 Detention under the MHA leaflet
You can receive the treatment you need but can remain at home or outside of a hospital setting so you will be close to your friends and family and in a familiar environment.
You will have support and regular visits from healthcare staff.
You can live in the community as normal but if you do not comply with the conditions of your section you can be recalled back to hospital and some people may find this distressing.
Some people might feel less supported outside of a hospital setting even though there will be staff that can be contacted at all times.
Some people may not agree with being on a CTO and may want to contest this at a tribunal.
Why is hospital helpful?
Being in hospital means you are supported by staff 24/7 so you are looked after and don’t need to worry as much about what is causing you distress. It means health professionals can monitor your mental health needs which will help them to know what you are struggling with and how best to support you. Some people find being on a ward calming, they feel safe there and feel reassured that there are doctors and nurses close to hand.
You will usually be on a ward with similar people in a social environment and will have activities and care throughout the day. Hospital wards offer lots of social and interesting activities so there’s a lot to do and many people make friends here. Whilst it can be a daunting experience it is also a time where you can have ‘time out’ from whatever was causing you stress and you can use the time to recuperate and to feel better.
What are some of the unhelpful things about hospital?
On the other hand being admitted to hospital can be a very distressing experience for any young person. If you are unwell you might not fully understand why you have been admitted, you might miss home, miss your room, family and friends and feel uneasy around new people. It helps to remember that hospital stays are usually only a short part of your treatment and that their main aim is to support you.
Will I be admitted to hospital?
If your health care team are considering an admission to hospital they will usually talk this over with you and your family. They will explain their reasons for this and see what you and your family think of this option. People are only admitted in certain circumstances such as:
Professionals take great care when weighing up the advantages and disadvantages of a hospital stay to make the right decision for you. For example they will try and weigh up the benefit of hospital treatment and care against you taking time away from school and your family. If you are admitted your hospital stay should be as stress-free as possible and the ward should be suitable for young people with your particular difficulties. The hospital should also be within a reasonable distance from your home so friends and family can visit.
What is a section?
People often talk about ‘sections’ and hospital. Not everybody in a hospital is on a section. When you go to hospital you can go either:
There are also lots of different types of sections; they differ in what can be done without your permission (just assessment or assessment and treatment), last different amounts of times and can be put in place by different people (for a review see Rethink’s section on the MHA).
If you disagree with being on a section you do have the right to a tribunal with a panel of professionals that are not related to your case and the right to have an advocate to help you.
What is a CTO?
A CTO is like a section that you have whilst living in the community. It can only be issued for certain types of sections and puts similar conditions in place as would be if you were in hospital.
Conditions could include where you can live, attending appointments, where you get medication and how you take it. It’s given so that you can leave hospital to be treated at home, but a doctor has the power to recall you to hospital if needed. It normally lasts for six months but can be renewed. A CTO will end when you are discharged (you are free of any conditions) or when it is revoked (if you are recalled back to hospital).
Why is it helpful?
You can receive the treatment you need but can remain at home or outside of a hospital setting so you will be close to your friends and family and in a familiar environment. You will have support and regular visits from healthcare staff.
What are some of the unhelpful things about a CTO?
You can live in the community as normal but if you do not comply with the conditions of your section you can be recalled back to hospital and some people may find this distressing. Some people might feel less supported outside of a hospital setting even though there will be staff that can be contacted at all times. Some people may not agree with being on a CTO and may want to contest this at a tribunal.
You can download the Trust leaflet: The Mental Health Act Section 17/117: Leave, aftercare; and supervised community treatment order (CTO)
HTTs are designed to keep you supported at home rather than in a hospital unit. HTT’s are teams of health professionals that work in the community and see you at home and offer intense support in times of crisis. They consist of psychiatrists, nurses and support workers.
HTTs support people with serious mental illnesses and those with substance misuse problems and mental illness. Teams may visit you every day or every few days and have longer working hours than most community teams. They also support people being discharged from hospital to make the transition back into community services.
In Birmingham we have 10 home treatment teams you can find details about them on our services map.
You can’t refer yourself to a HTT, you need to get a referral from a medical person such as: A&E departments, your normal GP, out-of-hours GP services, a CMHT team / duty team, your care coordinator, other primary care professionals, inpatient ward clinician or other secondary services, or a police station.