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Hospital Admission & Acute Care

Overview

Going to hospital can be an important and helpful part of the mental health journey. Some people avoid hospitals altogether while others put off going to hospital as long as possible. However, it’s worth keeping in mind that a hospital admission is only one part of the mental health journey and not everyone will visit hospital.

Statistics for mental health-related admissions in 2014-15 tell us that:

  • There were more than 254,800 admissions
  • More than 3 in 5 were for specialised psychiatric care
  • Almost a third of psychiatric care admissions were involuntary
  • The rate of mental health-related admissions was highest in patients aged 35–44
  • Depressive episode (17.4%) and Schizophrenia (13.5%) were the most commonly principal diagnoses reported

Despite the hospital admission numbers, feedback shows that people do best when they are cared for in their own homes and community. The aim of hospital based mental health services is to keep people out of hospital and ensure they have the supports they need.

Those who do go to hospital are not alone.  In fact, our contributors have experiences of going to hospital themselves or supporting a loved one through a hospital stay.  And as seen from the numbers above, it’s common for people to receive admission based psychiatric care.

If it’s an emergency or crisis

Call triple zero (000) if the person is in immediate danger

If someone is struggling to cope, is having suicidal thoughts or appears to be in immediate danger of taking their own life, call triple zero (000).

The emergency officer will ask “Do you require Police, Fire or Ambulance?”

Let them know which service is needed. 

Give the address of the emergency, plus any cross reference or landmarks that may help the emergency services to locate the person(s) at risk.

The emergency officer will ask several questions to ensure the paramedics have the critical information before they arrive.

Try to stay calm and speak slowly when describing the situation.

Listen to the advice given, follow any instructions, and assist the person while waiting for the paramedics.

Don’t hang up until the operator says so.

Call 000(Opens in a new tab)

The following are some organisations that provide 24/7 support for people experiencing mental distress and their families and carers:

Beyond Blue supports people concerned about anxiety, depression or suicide. Call 1300 22 4636 or chat online.

Kids Helpline for young people aged 5 – 25. Call 1800 55 1800 or chat online.

Lifeline crisis counselling and suicide prevention services. Call 13 11 14, text on 0477 13 11 14 (12pm to midnight AEST) or chat online.

MensLine Australia offers support to men. Call 1300 78 99 78 or chat online.

Open Arms — Veterans and Families Counselling for anyone who has served in the defence forces, and their partners and families. Call 1800 011 046.

Suicide Call Back Service for anyone who is considering suicide. Call 1300 659 467 or chat online.

13 YARN to talk with an Aboriginal or Torres Strait Islander crisis supporter call 13 92 76.

View more helplines(Opens in a new tab)

 

 

If worried about someone, they’re not in immediate danger but it’s hard to know how to help them get to hospital, then there are several options that can assist.

Online and Self Help

General Practitioner (GP)

Professional Support

Community Support

Psychological Support

Get help now

Choosing a Hospital

There are many things to consider when choosing a hospital for mental health care and it is important to acknowledge that at times of crisis or for those living in remote areas, selecting from a list of hospitals may not be an option.

If you are in a position where you can plan head and aren’t sure where to start, we’ve created a list of questions to make it easier to research the best hospital for mental health care:

  • What kind of emergency is it? How urgent is it?
  • Are there any hospitals in the area? If none in the area, which ones are closest?
  • At these hospitals, do they treat people who are feeling mentally unwell?
  • Is it easy to get a bed? How long do people normally have to wait to be admitted?
  • Are they public or private hospitals? If private, how much do they charge?
  • Do patients need to have private health?
  • Which private health have a contract with these hospitals?
  • Do the private health insurers cover part or all of the treatment costs?
  • Would it be best to be treated as a public patient or at least in a public hospital?
  • What have other people said about their experiences with these hospitals?
  • Do the hospitals offer information about their procedures, treatments, specialists, and what to expect when admitting to hospital?
  • What happens if there’s a change of mind and a patient wants to go home?
  • What programs and facilities do they offer people admitting due to mental distress?
  • What wards are patients admitted to?
  • What supports do they offer carers, relatives and friends of the person being admitted?
  • Do they partner with services that support people to transition from hospital to home?
  • Do the hospitals allow patients to bring their own supports onto the wards?

These questions can help create a shortlist list of hospitals to compare. Next, decide which one sounds like they would provide the best care and treatment.

The Hospital Journey

So what happens if someone has to go to hospital for mental health care?

The journey to hospital can start a long time before actually getting to hospital.  This can include a long period of mental health decline with visits to a community mental health support service, GP, psychologist, or psychiatrist.  It may have included visits by the police or the crisis intervention team, and short visits to the emergency department and assessment by an acute care team.  Or it could be a recurrence of a mental health crisis or a significant first crisis.  Whatever has happened, if hospital finally becomes the go to option it’s because a period of intensive hospital support is needed to keep everyone safe.

There are two main pathways of going to hospital.  Voluntary admission is when someone chooses to go themselves.  A voluntary admission commonly occurs after talking with a GP, family members, psychologist and/or psychiatrist.

An involuntary admission, also called scheduled or sectioned, is when a person doesn’t want to go to hospital or doesn’t think they need to go.  They might think they aren’t unwell or think they can care for themselves at home.  Involuntary/ scheduled admission is the result of others deciding a person needs to go to hospital.  Importantly, someone can go to hospital as a voluntary patient, and then be scheduled or sectioned when they are there, meaning that they can no longer leave when they want to.

Someone can be admitted and remain in hospital involuntarily because of the Mental Health Acts. Mental Health Acts are slightly different in each state in Australia.  For more information on admission criteria for each state and Territory see ‘Legislation and Your Rights’.

The Mental Health Acts are the authority under which someone can be taken to hospital and be required to stay in hospital for treatment, when they don’t want to be there.  The criteria for admission to hospital looks a bit different in each state, but they all have much the same function.

The criteria for admission to hospital for mental health treatment includes:

  • The person is assessed as unsafe to themselves or unsafe to others
  • They require treatment for their mental health
  • They can’t be treated in the community and hospital is the only suitable option

When a person is mentally unwell it can be hard to know what is going on or to understand what is being said to them.  This can add to a person feeling anxious and not in control.  Before someone becomes really unwell, it can be worth thinking about ‘what if I need to go to hospital?’ Having a bit of an idea about hospitals in advance could prove helpful down the track.  Even if a person themselves aren’t interested in thinking about hospital, family and friends might want to equip themselves with some prior knowledge:

Below are some points to consider about going to hospital:

  • know how to prepare for an admission and a stay in hospital
  • know how and why a person is to be admitted
  • understanding what will happen when arriving at hospital (what to expect, required processes)
  • understand the treatment regime and options (medications, psychological support etc)
  • know about the treating team (what people and their roles)
  • know how a person should be treated (rights, what the hospital can and can’t do)
  • understand all the internal and external support options

Arriving at hospital, either in an involuntary or voluntary capacity, is most often via the hospital emergency department or a visit to the mental health acute care team (called different things in different states).

Once at the hospital the beginning part of the process is the mental health assessment. This is a basic and important requirement and will occur whether or not someone is to be discharged later or admitted to a speciality mental health ward (the psychiatric unit).

The aim of the assessment is to find out if someone is well enough to be treated in the community, in which case they will be discharged, or if they need to be treated in hospital for a period of time. If they are to be treated in hospital they will be admitted to a special mental health unit, also called a psychiatric unit.

Hospitals can be busy places and feel very alien and strange. This can be more so when someone is feeling unwell and distressed.  Assessments are detailed and take time. It can be frustrating answering lots of questions, which is even harder when someone has strong thoughts or big emotions and/or doesn’t think they need to be at the hospital. Assessments could involve a variety of mental health professionals depending on which hospital you go to or the location of that hospital.

Most larger or urban hospitals will have a team of mental health professionals including mental health nurses, social workers, acute care teams, medical doctors, psychologists and psychiatrist.  There might also be consumer advocates, care consultants, security staff, paramedics and police, depending on the circumstances leading up the hospital visit. Smaller rural hospitals might have mental health nurses and social workers, but use video calls to psychiatrists at other locations. Some hospitals may have Cultural Liaison staff supporting Aboriginal and Torres Strait Islanders and people who have English as their second language.

The mental health assessment will gather information from the person themselves and family and friends where appropriate. It will usually including the following types of questions:

  • What sorts of things is the person doing and/or saying when they arrive in hospital (or not doing and saying)? What was the lead up to them being there on this day?
  • Is there any concern for the safety of the person or the safety of others?
  • Does the person have a mental health history, if so what is it?
  • How is their physical health?
  • Are they using drugs or alcohol?
  • What is the person’s social situation and what has it been like in the past?
  • Have there been any recent disruptive events in someone’s life?
  • What strengths does the person have, what do they want to happen in their lives going forward?

The assessment will inform who will be part of the treating team and the development of a care plan focused on recovery and returning to the community.  The care plan will outline how a person will be treated, look at early warning signs and relapse prevention, and identify life skills and goals.

When going to hospital, it’s again worth remembering that hospitals can be difficult and sometimes scary places for people experiencing mental distress. Even those who have been to hospital before can find them harsh and distressing. For people going for the first time, it’s not uncommon to feel very anxious and unsure about what will happen.

Newbies might see and hear things they never have before, and it can be unsettling and hard to adjust. A stay is hospital can be a short trip to the emergency department for a day or overnight, or a longer stay in a psychiatric ward. It will depend on the situation.

The hospital is full of people who know and understand what experiencing mental ill health is all about. Both the staff and other folks in the ward can be a hive of useful information and ideas. These supports can help a person to regain their strength and feel like they are getting back in control.

Also, it is not uncommon for people to make friends and have conversations with others who have similar experiences, while in hospital.  Hospital can feel like a safe place where people can be themselves.  At home, some people might try not to show how they are feeling, or say things, for fear of upsetting their loved ones. In hospital people don’t have to hide what they say or do. Hospital can be a ‘time out’ space.

For family and friends who might be worrying about a person, knowing that person is in a safe place and being cared for, can help them too.  They might also gain useful networks and new ideas to further support their loved one in the future.

Getting out of hospital (being discharged) can occur when a person’s mental health care team agree that they are well enough and can now be treated in their community or moved to an external support facility as a stepping stone to going home.  The psychiatrist makes a recommendation and the team will commence the process.  It is not uncommon for a person to think they are well enough to leave hospital but the Psychiatrist does not.

The Mental Health Review Tribunal (called different things in different states) is also a player in the discharge process. The role of the Tribunal is to hear all the necessary information from all parties involved, and make a decision about care being provided in the community or remaining in hospital. Appeals can be made to the Tribunal regarding its decisions.  Each state or territories Mental Health Act will outline the role of the tribunal and options to oppose its decision.  Where people are unhappy with their treatment or the decisions regarding their treatment, they can make a complaint. See the ‘Making and mental health related compliant’ section, further down.

The discharge process can take time, and where possible is coordinated by the discharge planner.  All aspects of the process should involve the person’s family, friends or other community care team members who will be providing support once they leave hospital.

Carer’s including family and friends also might need support when someone is discharged from hospital, regardless of where they move to.  Local supports for carers can be located through the Carer’s Associations on 1800 242 636.

Doing some preparation to leave hospital is important. Planning could include:

  • Making a list of what needs to happen in order to leave hospital and return home (or onto another support facility)
  • Follow up with a GP as soon as possible to ensure any medications prescribed in hospital can be accessed once at home
  • Stay in contact with a GP or mental health case manager (if one has been assigned)
  • Stay on top of the mental health care plan with a GP and case manager
  • Use all community supports available including telehealth services if in rural locations

After a period in hospital it can be difficult for someone to adjust back to living independently in the community.  They might need additional support for a period of time to assist the transition. Transition support options are considered as part of the discharge planning process.  These include:

  • Community mental health centres
  • Community care units
  • Private psychiatrists
  • Mobile support and treatment
  • Prevention and recovery care services
  • Residential rehabilitation
  • Home-based outreach
  • Psychosocial rehabilitation day programs

The local mental health services will be able to provide information about each of these options; what they provide, entry requirements, visitor access etc.

It is the right of people living with mental illness and their families and friends, to get a second opinion or make a complaint when they feel something is not right. This is especially the case if someone feels their rights have not been upheld.  Complaints can include the treatment and care a person receives and their involuntary or scheduled status.

The process of complaints is slightly different in each state and territory, but all services and agencies that provide mental health services should have a complaints process.  Details of these should be displayed on the walls of waiting rooms and offices, but in some cases have to be requested.

Commonly the Mental Health Review Tribunals or Mental Health Commissioners can be good starting points, as can making a complaint directly to the hospital or agency involved in the treatment and care. It is useful to ask for a copy of the complaints policy/process, a copy of the complaints form (if required), and clarify to who and how the complaint should be lodged. Sometimes services might overlook a complaint if the correct process is not followed.

Support with the complaints process can also be sought from the Independent Complaints Officers (or the equivalent), Mental Health Complaints Tribunal, Carer Consultants, Official Visitors, Legal Aid, citizen rights and advocacy agencies etc.

Below is a list of option by State and Territory to get you started.

Victoria

Queensland

New South Wales

ACT

Northern Territory

South Australia

Western Australia

Tasmania

National

What to expect in hospital

Some things about being in hospital (a psychiatric unit) can be very hard to cope with, particularly for people going to hospital for the first time.  These include:

Yes, the wards are locked. Psychiatric wards are termed ‘secure’ wards. People cannot get out or in without official access and approval. For a person who has never been ‘locked in’ a secure facility before this can be very difficult to cope with.  Although this is for everyone’s safety, it doesn’t make it feel any better.

How long someone has to stay in the psychiatric unit will depend on how unwell they are, and how they respond to treatment. Overnight stays are common, as are stays of 7-8 days. People can remain in the psychiatric unit for months if needed. Regular reviews are an important part of the treatment plan.  No one wants to stay in hospital any longer than necessary. As people start to recover, they may have day leave, overnight leave, or weekend leave. Transitioning to a non-secure mental health support facility or program is common to help people to readjust post admission.

Psychiatric wards do not allowed smoking. Cigarettes and tobacco will be handed to the administration staff upon entry.  A ‘smoke break’ has to be requested, and there are rules about how many smoke breaks a person can take during a 24 hr period. This is usually reliant on how many staff are available, as a staff member has to accompany someone on their smoke break.

Family and friends cannot usually come and go as they please. There are visiting hours, and contacting in advance of a visit is recommended. There may be some acceptations to this in different locations and communities.

Part of the expectation of being in hospital (and under the Mental Health Act) is that people comply with their treatment plan. This usually requires people to comply with the direction of the ward staff, taking their medication as prescribed, attending appointments with psychologists, and reviews with Psychiatrists etc.

Some wards provide access to tea/coffee, cold drinks and snacks. They many also allow small processed snack items to be bought in. Generally people are reliant on hospital food, which can be difficult for people with specific dietary requirements.

When behaviours become too disruptive or potentially threatening, staff may be required to physically handle people (restrain them) to calm them down or remove them. Most wards have an area where people who need extra space can be safety put for a period of time. During this time, they will receive regular support and on-going review until it is safe for them to return to the main ward.

People are in hospital because they are unwell. This can include thoughts and actions which can be disruptive and distressing to others, such as crying, talking to themselves, mood swings, loud calling out, arguments etc.

 

The patient’s rights

It can be useful to have an understanding of someone’s rights, before they have to go to hospital. This includes the rights of carer’s, loved ones and other support people.

The rights of people living with a mental health condition are the same as those who do not live with mental ill health. They are based on being treated according to the Human Rights Act 2004, and the various mental health Acts and charters.  People should expect to be treated by a care team who will care and work with them, be equitably in how they provide services, and in a way that is free from discrimination.

While in hospital, people and their carer’s have the right to:

  • be treated with respect
  • know they will be safe in the hospital environment, their treatments and side effects
  • be heard, informed and ask to questions
  • have access to services and support, including advocacy
  • participate in decisions and process
  • privacy
  • comment, get a second option and make a complaint if needed

View the Australian Charter of Healthcare Rights for an example.

Carers, loved ones and other support people should be involved in care and treatment decision-making, alongside the hospitalised person, in keeping with that person’s right to privacy.   These rights tend to be fairly standard across the states and territories, and laid out in the different mental health acts.

View the Rights of Family, Carers and Other Support Persons Fact Sheet for an example.

Find the charter of rights for your state

Family, carers and friends

Few people want to be admitted to hospital, but caring for people in the community can be challenging. Those who don’t experience a mental health condition tend not to understand what living with mental ill health means for people and what they and their loved ones experience on a daily basis. It can be particularly hard for family and friends who are usually the first to realise that someone is struggling with their mental health. It is not uncommon for family members or friends to be the ones who have to take a person to hospital for assessment, even if the person themselves doesn’t recognise that they are unwell.

Having to take someone to hospital when they don’t see the need, or don’t want to go for some other reason, can be very distressing for everyone. Family members might end up being blamed or feeling guilty for doing what they think is best for the person, and the person themselves might feel misunderstood and let down.

It’s important to remember that although family and friends might be the ones to take a person to hospital in the first instance, once there they are under the care and decision-making of mental health professionals.  It is these professionals who will assess if someone requires to stay in hospital or can return home.

Next Steps

If you’re considering admitting to hospital for mental health, the first step is to talk to your GP.  They can guide you to help ensure you get the right kind of supports and the help you need to request support when in hospital and when leaving hospital, so that you get the support to transition back into home and the community. Because there are support workers who can support you through your recovery.

Find a GP to discuss hospital admissions

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