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If you feel you are at risk and need to go to the ER/A&E


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I started this as a suggestion and was advised by Stacia to post it here. This isn't a question, it's some advice.

If you're anything like me, there are times when you feel quite unstable. Here's some advice regarding admitting yourself to the ER/A&E:

1. When to admit yourself:

If you have reached a point where you are at risk of seriously harming yourself or attempting to commit suicide, go to A&E. Even if you aren't sure if you're really in danger, I find that it's better to be safe than sorry. I would apply this especially if you are alone at home. If you are in that kind of a state, no matter how much you want to avoid people, you need to be with someone. In A&E, at least you know you will be safe from any further destabilisations of your mood.

Also: if you experience any new symptoms/worsening of symptoms, and you can't contact your GP/Pdoc/Tdoc (say it's two in the morning or something) then I would advise going to A&E. They will be better equiped to help you deal with it and stay safe.

2. Before you go:

Make sure that someone knows that you've gone - a parent, sibling, friend, anyone. Someone who will be able to check up on you. Also, whilst you're there try to keep them up to date on what is happening. This way, if anything happens there will be someone outside of the hospital who knows your situation and can step in to help you.

(For example: When I went, my parents were out of the country. My boyfriend was the one who ended up dealing with them freaking out after they got a phone call at two in the morning that their daughter was in A&E.)

3. What to take:

(Disclaimer: This is for if you know you're going, not the kind of situation where the police and paramedics have to bang your door down and rescue you. Then you're probably not going to have time to pack an overnight bag.)

-Pyjamas. Preferably not the sexy ones you wear when you're trying to score with your S.O. Comfortable ones. Oh, and warm ones. It's almost always freezing cold in A&E, and they don't believe in providing luxuries such as blankets (at least, not in the UK).

-A book/some other entertainment. You will do a lot of waiting around.

-Something that calms you down. A soft toy or something? I took a teddy bear. An iPod, so you can listen to calming music? There probably isn't going to be a nurse watching you and calming you down all the time. They tend to be taking care of more than one person at a time.

-A spare change of clothes, a toothbrush, and deodorant. Also, any other luxuries/comforts that you need.

-Your phone. You probably will have to walk to the other side of the world to get signal, but it's useful to have, obviously. Especially the next morning, when you get discharged and you need someone to pick you up.

4. How to get there:

Preferably, if you're going voluntarily, get someone to take you. Make this someone you trust, who you know will stick up for your rights/what you want. Also, preferably, someone who is up to date on what meds you're on, etc. It also helps if it's someone really, really nice, who will stay with you all night and help calm you down.

This is really the most adviseable way to get there. If you're in a suicidal state, you're probably in no state to drive. Especially DO NOT drive if you have ODed or anything like that. As a last ditch resort, you can call 999/your local emergency number, and in most countries suicidality is enough of an emergency that they will send an ambulance (I don't know about this for every country, so don't take my word on it).

5. When you get there:

Go to A&E and hope the receptionist isn't busy filing her nails or something. Seriously. Tell the truth, but keep it brief. Don't worry, you're going to be explaining yourself a lot during your stay.

The receptionist will send you to a nurse who will assess you, then send you to another nurse, etc. Eventually, they'll probably stick you in a bed and tell you to wait until they can get hold of psychiatrist.

Disclaimer: This is my experience only. Obviously, if you have actually done yourself any harm they will patch you up. Well, they should, and if they don't then make sure the person who took you to A&E gets them to do so. If you've ODed, they take that seriously, even if it's only a "minor" OD (I'm not condoning ODing. I just mean if you didn't take anywhere close to the LD, they will still take the behaviour seriously).

Eventually, you will see a psychiatrist OR someone from the mental health team. Not knowing what hospital you're at, I can't guarantee which, or when. If you go in in the middle of the night, you'll probably be there for a while yet. The mental health team is not the most efficient.

6. General advice:

The nurses are over-worked, harrassed jerks. No offence to any nurses on here! You're probably not going to get a lot useful out of them, and they're certainly not going to do it with a smile on their faces. Also, you won't be their only patient, so you'll have to wait around.

Make sure that you have a plan to pass on any relevant information about your meds and diagnoses, as well as any allergies you have and any past conditions you've suffered from.

I'd advise telling them the whole truth, because otherwise they a) aren't going to take you seriously, and b) aren't going to be able to help you effectively.

7. Finally: when you leave:

You can't just walk out. Everyone has to say that you can leave (mental health team, doctors, nurse). The person with the final say is your nurse, who will sort out your discharge papers. Make sure you have someone to pick you up, or ask the hospital to organise transport for you.

I hope this helps people. I know I could have done with something like this before I went, if only to know what to expect when I got there.

Good luck!

Finally, for more advice, karuna linked this form on the Self Harm board, which is also quite useful:

http://www.palace.ne...ych/erform.html

And Titania has a blog post here that says it more coherently than I ever could:

http://dedicationtorecovery.wordpress.com/2010/11/04/how-to-self-refer-through-accident-and-emergency/

Oh, if anyone has anything to add, let me know and I'll edit my post. I'm sure other people out there have more extensive knowledge that they can share!

N

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My boyfriend who was with me kindly added his point of view. I know this is a first person site, but I think some of us are still in the position where we need to help out someone else, so I'm posting it anyway. Mods, feel free to remove it or whatever if you don't think it belongs.

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A few tips from HallowedInk’s SO:

First things first, if the person you are with is suicidal, definitely go with them. It gives the sufferer, you and anyone that cares about the sufferer some peace of mind. The hospital is a busy place during the day and there are too few people on at night to help immediately.

Sitting with the person in the early part of the incident can be especially helpful, as there is precious little to stop them from doing more damage, when the implications of telling a doctor “oh yeah, I tried to kill myself,” sinks in.

Another important role can be explaining to the nurses/doctors/anyone else that might give a shit what happened or fielding phone calls from concerned friends and relatives (see the part where there is no signal in a hospital, and the suicidal person can’t very well leave the ward to find the elusive signal).

Keep up to date with the person’s medication, mood, diagnoses, and if possible try to discuss what happened to them. The person you are with will often be in a state where trying to explain that they tried to kill themselves or feel unsafe is very difficult. Make sure you know important things like next of kin, addresses and their GP’s name and practice.

What to take:

A phone, charger (and preferably your friend/SO’s charger), this really alleviates the panic of relatives phoning up to find out where they are.

Take everything the other person takes, as you are the one going to be dealing with quite a lot of the doctors’ questions, and in all likelihood you will not be offered a bed. If your friend/ SO have the good fortune to fall asleep, you may have to field all of the questions about them, and will often be called upon to confirm what the other has said. Take some water, a lot of hospitals only offer hot drinks to patients, so hangers-on will have none.

Bring a pillow, or a big comfy jumper or something so that you can get a bit of shuteye during the night. I managed to share half of HallowedInk’s bed, but hospital beds are very small, and for the first hour I was stuck in some sort of visitor’s lounge where all the male nurses had continuous loud conversations about their shifts and their families in East Timor (no really!).

Maybe an ipod with noise cancelling headphones would be good. Hospitals are very noisy, with heart rate monitors always bleeping, there is always one completely intoxicated idiot screaming or shouting or making noise.

Very importantly in the case of an OD, take all of the empty packets, pill boxes etc. This can save time during questioning about the incident, when your friend could benefit from activated charcoal or a gastric lavage. It could save the person’s life and will help to guide the physicians in treating you.

Be aware that the doctors may want to talk to you privately. In my case HallowedInk had gone to sleep so I dealt with a psychiatrist and desperately tried to recall all of her history. Top tip: If the person you have taken has a list of disorders because they have trouble talking to doctors, take that.

Finally a lot of places in the UK charge for parking (greedy so and so’s), so bring change. The little shop is generally closed at night, so don’t count on being able to generate change from shopping.

You may also need to cajole the staff to find out where the doctor went, where your friend went, when you can get discharge papers, if there is anything important to know. This is vital in the event of an OD, where any drugs which are prescribed may have to be looked after by you, rather than your friend. It would be a shame to go to all this effort only to have them take a bigger OD back home.

Be assertive, but not aggressive when cajoling and pushing things along. If you feel the nurse has completely forgotten about your friend, it doesn’t hurt to ask how long things will be. Shouting at the nurse (satisfying as it might be) won’t achieve anything. Play nice, your friend has a hard enough time already.

It may help to be family or the same gender as the person. I was only allowed onto the female ward after HallowedInk woke up, but there would have been much less of an issue had I been the same gender. That said anyone there is still better than no-one. Some wards will be picky about the number of visitors, or about visiting hours. Looking confident and saying that your friend is probably very upset and needs comfort will probably work well. This goes both ways. Make sure you tell the friend to ask for you if they need you, and tell the nurses to tell the friend that you are waiting outside the ward if needed.

If you are unsure of something or need to clarify something ask the staff. They might know that the friend is in cubicle 8, but you don’t. This is also vital for finding the toilets.

All in all, good luck!

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For those of you in Australia, familiarise yourself with the local CAT Team number. Their job is to assess whether you should go to hospital. You can call them to just chat, or they will actually come to your house if you need them to/if they think they need to. As far as I know, a family member or friend can call them for advice too. Of course, if you already know you need to go - just go.

CAT Teams

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I just wrote up a semi-long reply, and then the interwebs ate it, so I'll write a condensed version now:

This is great advice. I especially like the point about telling someone - anyone. When I was in need of hospitalization, I was really afraid of facing stigma, so I didn't tell anyone. My best friends didn't know until about six months after, when I let it slip out that I'd been hospitalized for my MI. If you have a friend/SO/family member who is willing to offer his/her support, take it. It'll take a little bit of teh suck out of the experience.

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