Addressing Concerns about Hospitalization

When patients with a first episode of psychosis are admitted to an inpatient unit, they may be concerned that they:

• will forfeit basic rights;

• will be incarcerated indefinitely;

• will be injected with chemically-restraining medications;

• are not unwell like other patients in the unit [42].

It is possible to address most of these concerns by providing patients with clear choices about their options, ensuring they have access to second opinions and legal assistance, and explaining their rights of appeal if they are subject to involuntary treatment. Most patients subsequently regard their period of hospitalization as a positive event which assisted them to recover.

It is particularly useful for the clinician who first had contact with the patient to accompany the patient and family to hospital, provide a sympathetic description of the hospital process, introduce them to hospital staff, and ensure a full orientation to the inpatient unit and its policies. If possible, avoid transport to hospital by ambulance or the police. Although police admissions are often uneventful and well managed, they have the potential to be traumatizing for the patient. Continued feedback and debriefing to the family is essential before, during and after admission.

Families also have concerns about hospitalization, particularly if it occurs involuntarily. If this is the case, it is important to ensure the family understands that:

• the final decision to admit as an involuntary patient is taken by the treating team, not the family, and this will be explained to the patient;

• if the situation continued, the family would have become increasingly exhausted, which would have hampered their capacity to provide care;

• without short-term intensive care, the patient would have become more unwell, resulting in an even longer period of time before recovery;

• staff are aware of many other cases where inpatient care enabled treatment to be initiated very effectively;

• inpatient care is only for the short term, and the treating team will be involved once the patient comes home again.

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