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It will likely take a long, frustrating trial-and-error
process before a treatment regimen is found that works best for the
patient.

Hospitalization - when and why is it necessary?

At some point or another, most people with schizophrenia will likely
have to be hospitalized for at least a short time. Hospitalization can
be voluntary (requested by the patient themselves) or involuntary, meaning
it is up to the discretion of the treating psychiatrist, emergency room
staff, or a courtroom (see
the criteria and procedures for involuntary hospitalization by U.S.
state). At the point of hospitalization, a person may be in pretty
bad shape - feeling sick, scared, out of control, and abandoned. Understandably,
at the time it's not a pleasant experience for anyone involved. But
it doesn't have to be something to fear.

Why might somebody need hospitalization, rather than outpatient
care?

• patient needs to be in a protected environment to keep them from
  harming themselves or others.


• patient needs to be monitored by trained professionals for symptoms
  and medication reactions.


• patient needs a safe place where they can stabilize and concentrate
  on recovery.


• family needs a short respite to gather themselves and make long-term
  treatment plans.





What can you get with hospital treatment that you can't get as an
outpatient?





• constant monitoring in a controlled setting, so medications can
  be adjusted more quickly and accurately. Hopefully, this means you
  start feeling better sooner.


• more time with a doctor and/or therapist, maybe every day. Trained
  staff members are always around to talk to about questions, concerns,
  or thoughts.


• group therapy, recreation programs, vocational/social rehab (programs
  will vary depending on the hospital)


• A safe place to gather yourself, get settled with medication, and
  stabilize so you can return to your own life as soon as possible.


• according to one schizophrenia.com member: "plenty of rest,
  free food, free laundry, you get to meet nice people, free recreation,
  [and] you get a chance to draw pictures and watch a show or two."

Many members of schizophrenia.com have written
about their experiences in hospitals (either voluntary or involuntary)
on the discussion boards. Most agree, at least in retrospect, that getting
treated in the hospital was the best thing for their health and well-being
at the time. Some of their thoughts are quoted below:

"It's nothing to be scared about. Try the meds they give
you and work with the staff. They are there to help and want you to
talk to them when you are having problems. The other patients on the
ward will have different illnesses than just schizophrenia, like bi-polar,
depression and drug addiction...Hopefully if you go you can get things
straighten out."

"I found that I was at my worst the two times I was at the
hospital. So I did not like being there at all. But it was a place
where I was safe, a place where I couldn't hurt myself or wander off.
The hospital is the place my healing started, and I find that it was
not an enjoyable experience but a helpful one."

"[T]he better your attitude about being hospitalized and
the more hope you have for yourself, the better you will do, I think.
I had faith that the medicine would help me from the beginning, and
it turned out to be true."




"[S]ometimes, as my pdocs have said over the years, we need
a "safe place" and sometimes that is the hospital."







Once it has been determined that hospitalization
is necessary, you may have a choice (depending on insurance, availability,
and your psychiatrist's recommendations) of what hospital to go to.
Psychiatric facilities include public hospitals (state, county, or community),
university (teaching) hospitals, private psychiatric treatment centers,
and VA hospitals. Dr. E. Fuller Torrey, in his book "Surviving
Schizophrenia" (pp. 180-188)offers the following suggestions
for evaluating psychiatric in-patient facilities:





• talk to your doctor, treating psychiatrist, hospital staff, and
  other families who are familiar with programs in the area; ask for
  their recommendations and reviews of various programs


• look for a Joint Commission on Accreditation of Health Care Organizations
  (JCAHO) accreditation. A JCAHO team, upon invitation by the hospital,
  surveys patient care and services, therapeutic environment, safety
  of the patient, and quality of staff and administration. The hospital
  may receive full 3-year accreditation, full accreditation with a contingency
  (meaning that a follow-up inspection may be warranted), or no accreditation.
  Bear in mind that accreditation is given to hospital as a whole,
  NOT to individual wards. Ask for JCAHO accreditation at the hospital
  administration office, or look for a certificate by the entryway or
  in the lobby.

• the quality of staff, first and foremost, should indicate the quality
  of the ward. Due to the staff, even individual wards in the same treament
  facility may vary in quality.


• do NOT assess quality by fees charged. Private facilities are not
  necessarily better than public ones. Again, evaulations of the staff
  at each location should guide you.





Hospitalization is no easy experience for friends
or family members either. Especially if commitment was involuntary,
family may be hesitant about visiting, unsure of how to react when their
loved one returns home, and fearful that their loved one will never
forgive them for making that hard choice. One schizophrenia.com member
had the following thoughts about committing her child:

"In the early years, I would grieve myself so badly I would
get physically sick. I felt so much guilt if I allowed myself the
slightest amount of pleasure, so instead would stay in continuous
grief mode. It consumed me day and night - all I could think of was,
what was what my child going through at that very moment? What kind
of a Mother could I be if I dared allow myself to read a book, go
to a movie, etc. when my son was locked up...

This I tell you serves no purpose. You need to be kind to yourself
right now. Enjoying a bubble bath, going window shopping, having a
laugh, does not mean you do not care and are not concerned. Instead
it enables you to focus on helping your child and keeping up your
spirits so you can show them a positive attitude."

Keeping a positive attitude, even through the difficult experience
of hospitalization, is something that many family members stressed as
important. As one relative said, "It's so important to be cheery
& positive when you visit them in hospital. I found it helped a
lot if I just talked as if I EXPECTED him to be better soon."
Some family

members are unsure about visiting, not knowing what to say
or if their loved one even wants to see them. Visiting might indeed
be difficult until medications start working - the ill person is not
feeling well, and may be angry, frightened, or even out-of-control.
In retrospect, most people who were committed agree that they needed
to be hospitalized at the time, and appreciate that someone was looking
out for them. Even if your loved one refuses to see you, or is angry
with you, showing your love and support by continuing to go is one of
the best things you can do. It helps to get through to them, even subconsciously,
that they have not been abandoned. Below are thoguhts on visiting from
schizophrenia.com parents:

"He hated us for putting him in there.... until the meds
kicked in. (He was never happy we did it, but never held a grudge
that we did.) We went each evening after work all the way to the hospital
to see if he would visit with us. The answer was always no, so we'd
turn around and head for home. But we went anyway. The reason? Because
we felt (and so did the psychiatrist we had then) that deep inside
that pile of rage and paranoia was our son. And that deep down inside
he needed to know that he was loved. So we went, were turned away,
and did the same the next day or so, until the meds had kicked in
and he wanted to see us."

Other things family members can do to make the hospital stay as easy
as possible:





• Get to know the ward staff, so they know that someone is actively
  interested in the welfare of that particular patient. These are also
  the people who will ultimately be able to explain to you what is going
  on with your loved one, and help address your questions and concerns.


• Arrange for a tour of the facility, and become familiar with admissions
  procedure, daily schedules, and visiting hours and regulations.


• Ask about any rules regarding bringing a patient gifts, photographs,
  or food.


• Ask to be notified when your loved one is getting ready to be discharged.
  


• Learn about the treatment plan, and find out what your role in it
  can be.


• Talk with the staff before your loved one is discharged about how
  to continue care at home, what signs might signal a relapse or a mdeication
  reaction, and how to make the transition to living at home as smooth
  as possible for everyone.

The following online resources have more information about the logistics
and experience of psychiatric hospitalization:

--involuntary commitment
- another section of the FAQs, deals with procedures for commitment
and common fears/concerns of loved ones making the decision.

--Let's
Talk Facts about Psychiatric Hospitalization (APA publication).

--Psychiatric
Inpatient Experiences - a personal voice on what psychiatric hospitalization
is like, and advice to make it a more positive experience.

--a public radio show about
mental hospitals (particularly Bellvue in New York)

--Psychiatric Hospitalization:
What It's Like on the Inside (radio program)

--Returning
Home - an online booklet for families about helping a loved one
transition back into the home environment after spending time in a psychiatric
facility.

The things that I have that I wish I didn't have are hallucinations,
delusions, and loss of thought control.

The things that I don't have that I wish I did have are curiosity,
motivation, and sex interest.

The above is pretty much the way schizophrenia goes.

• insurance problems and driving licences


• befriending and leisure activities


• finding appropriate accommodation with any necessary support


• sheltered employment and training for work


• benefits problems and debts


• legal rights and advocacy


• genetic counselling


• treatment, including medication and complementary therapies


• representation at tribunal, court or inquest

Childhood
Schizophrenia by
Shiela Cantor - Hardcover: 193 pages

Publisher: The Guilford Press (June 3, 1988) ISBN: 0898627133

Review of Childhood Schizophrenia: "The concept that a child could
have a serious or chronic mental illness has always been difficult for
health and mental health professionals to accept or understand. With
autistic children, it is not possible to deny the seriousness of the
disorder. For other psychotic children, those who look normal and in
many ways act normal, it may be difficult to see the child as psychotic
or to accept the seriousness of the disorder. Cantor addresses these
children. She reviews the literature--a literature that reflects this
ambivalence--and then presents her clinical concepts and approaches
to treatment for childhood schizophrenia, based on a review of other
clinicians' work and on her clinical and research experiences. Perhaps
the greatest value of her book is that Cantor forces us to think clearly
about this serious and chronic childhood disorder." --Larry B.
Silver, MD

Divided
Minds : Twin Sisters and Their Journey Through Schizophrenia
by Pamela Spiro Wagner and Carolyn Spiro, M.D. Publisher: St. Martin's
Press (August 1, 2005). ISBN: 0312320647.

Recovered,
Not Cured by Richard McLean. Publisher: Allen & Unwin. Currently
available for ordering from the publisher in Australia - will be available
in the US, Canada, Japan in May 2005.