Emergency mental health care

Your loved one may have a limited attention span, find it hard to concentrate, or find it difficult to listen. Here are some tips on how best to communicate with them:

• Stay calm. Talk slowly and use reassuring tones.
• Ask simple questions. Repeat them if necessary, using the same words each time.
• Give your loved one lots of space (physical and emotional).
• Say, "I'm here. I care. I want to help. How can I help you?"
• Don't take your loved one's actions or hurtful words personally.
• Don't say, "Snap out of it," "Get over it," or "Stop acting crazy". 

Voluntary hospitalization involves a person who willingly agrees to receive psychiatric care in hospital. A person who signs in voluntarily may ask to leave; the hospital must release people who make these requests unless their needs have changed and they are a danger to themselves or others. 

Involuntary hospitalization involves admitting a person with symptoms that are so severe that they cannot listen to others or accept help, or relate to those around them. A doctor can decide if this person is to be admitted as per the B.C. Mental Health Act.

• Talk with your loved one about the behaviours you have seen.
• Assure them that the hospital is a safe place for severe symptoms to pass and for medication to be adjusted.
• Tell your loved one that getting help does not mean they failed. A mental illness is just like any other illness that needs treatment, like diabetes or heart disease.
• Help your loved one pack comfortable clothing and safe items that are reminders of home.
• Offer the person choices, such as going to the hospital with you or with another loved one.
• If your loved one is still resistant to this option, consider consulting the Access and Assessment Center (AAC) or police involvement. 

• The police/RCMP will gather information about the situation and may attend in-person to speak with the individual of concern on the same day or will arrange to respond at another time.
• When the police/RCMP attend in person, they will inform your loved one of their role and why they are there.
• They will assess the situation and the health of your loved one. A community mental health nurse may also attend with the police to help assess your loved one.
• If your loved one requires further assessment of their physical and mental health needs, they will be advised to follow up with a treatment plan.
• If the situation requires more immediate action and the person refuses to get help, the police/RCMP will take them to the hospital; the police will stay until a physician assesses the person. 

A nurse will check-in your loved one and coordinate an assessment by a physician and/or psychiatric nurse, as well as maybe the on-call psychiatrist. The physician will decide if the person should be admitted voluntarily, admitted involuntarily or be discharged and/or treated in a home environment.

When your loved one admitted to the psychiatric unit, they will be assigned a bed and their valuables (including their cell phone and other electronic devices) will be securely stored. Once settled in, patients can use a phone on the unit to send and receive calls.

Your loved one will have a care team that may consist of psychiatrists, nurses, social workers and occupational therapists. A social worker provides a link between the family and the care team, assists with scheduling family meetings and with discharge planning, and provides referrals to community resources and housing. A psychiatric nurse observes and documents clinical symptoms and provides ongoing one-to-one treatment, which may include medication, therapy and education.

• Provide the contact information for one support person to communicate between the care team and family/friends.
• Check with the nursing staff about bringing personal items to your loved one.
• Respect visiting hours so that your loved one can participate in treatment programs during the day. Exceptions require advance permission.

If the hospital is not the right place to stabilize your loved one, they may be directed to services such as acute treatment, community programs and other safe places.

A patient may return home if treatment has stabilized them and/or an assessment determines they are not a harm to themselves or others – or in other words when they no longer meet one or more of the involuntary admission criteria set out on Form 4: Medical Certificate (Involuntary Admission).

Patients stay in a psychiatric unit an average of 15 days. A patient who is voluntarily admitted may ask to leave and the hospital must release them unless their needs have changed and they are a danger to themselves or others. A social worker who is on your loved one's care team can assist with discharge planning.

Before your loved one leaves hospital, the treatment team will help with completing a "When I Leave Hospital" Form, which identifies the follow up appointments and community resources identified for follow up care. Depending on resources offered or referrals made, your loved one may receive ongoing care in the community.

Prior to discharge from hospital, patients may be referred to acute and short-term services or community programs for ongoing support.

Your loved ones can also access the following resources after leaving hospital:

• MindHealthBC for evidence-based online service that offers information on local support groups and other valuable resources.
• Mental health outpatient services.
• The Access and Assessment Centre (AAC) for supports offered include assessments and crisis management.
• A crisis and information phone line.

Families and friends can connect with VCH Mental Health and Substance Use Family Advisory Committees who work to improve the care experience of patients and their families. The committees support family involvement, ensure that mental health and substance use service delivery reflects best practices of and family-centered care and support a culture of recovery in mental health and substance use services.

If you believe there is risk of harm to your loved one or others, and they cannot safely go to the nearest hospital emergency department, call 9-1-1. Your loved one may be taken to hospital by police to be assessed by a doctor if police believe your loved one is at risk of harm to themselves/others. 

If there is a non-life threatening mental health/substance use concern, options include encouraging your loved one to:

• Reach out to their physician/community mental health supports; if your loved one declines to connect with their care providers, you can connect on their behalf to provide collateral and discuss options.
• Call or visit the Access and Assessment Centre (AAC).