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If you were accidentally placed in a psych floor in a hospital, what would you say to convince the medical staff that you didn't belong there?

First of all, no one is “accidentally” placed in the psychiatric unit. Yes, there are misunderstandings that can occur. So, let’s say you were under an involuntary commitment and have no recollection of the events, no prior psychiatric history, etc. In that case, tell the truth. For example, if you had 3 too many drinks and started acting crazy, then state just that. Also, don’t hibernate in your room. Socialize on the unit, participate in groups, play games, laugh, or in other words, be visible and don’t look depressed. Act like you are enjoying it and we are sure to kick you out the door. Most insurance is not going to pay for a primary substance abuse stay in the inpatient psychiatric unit. Believe it or not, there are physicians who will keep you on the inpatient unit for as long as your insurance allows. Unethical? Absolutely! But, also unfortunately true. Do you have a friend or family member that can attest you were not having mood issues prior to admission? That is worth quite a bit in your favor.

The second “misunderstanding” I’ve seen occur is when a patient makes a statement to some healthcare provider, often in the ER, such as, “if I have to be in pain all night, I may as well kill myself!!” Boom, involuntary admission. Come on now, this is a figure of speech used often. Do we need to take threats seriously? Yes, of course. But, that also means exploring a bit more with the patient, after the statement is made. Was this a statement made to manipulate the provider for pain medication? Was it an expression to relay the level of discomfort? Do they really mean they want to die….now….tonight? Probably not. I’ve also seen plenty of patients admit to chronic daily suicidal thoughts and end up in the hospital. If they have had the thoughts for 5 yrs, never made an attempt and are not reporting worsening symptoms now, then how will a hospitalization be of benefit acutely? In these cases, the truth is the best option.

Now, if there is a documented history of mental illness, it’s a bit more complicated. Is it the 10th failed suicide attempt? As long as the attempts were not serious, you could say you were out of town and missed 2 days of your medication and that was the cause of the relapse. Or, you could assure the staff you are staying with a family or friend, who will be with you 24/7 for the next week, and you already have an appointment with your own doctor, and are not an acute danger to yourself. Of course, that would be verified prior to discharge.

The bottom line is that the inpatient psychiatric unit is for crisis stabilization. There is no real “treatment” that occurs there, other than medications. Medication for depression can take a month or longer to start working, so just getting past the crisis stage is the goal. If you don’t need medication, and are not in active withdrawal, you’ll get discharged fast. We watch your actions more than your words, so what you do has much more weight than what you say. Hospitals want to make money. There is a shortage of psychiatric beds all over the country and most places will try to discharge you the first possible moment. Most patients are discharged prematurely and not the other way around. Chances are, if they keep you past a day or two, you probably need to be there. If you are there for harming someone other than yourself, expect to stay much longer, and it won’t be easy to talk your way out.

Schizophrenia was not addressed. We see through you and yes, we can read your mind!

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