Going into hospital
If you have a mental illness, most of your treatment will be outside hospital. Doctors call this treatment in the community. But you may need to go into hospital if you become unwell. This page has practical information about going into hospital.
- If you want to go into hospital, the hospital staff might call you a voluntary patient. This means that you can leave if you want to.
- You might have to go into hospital when you don't want to. Doctors call this being detained under the Mental Health Act. If this happens, you will not be able to leave unless the hospital doctor agrees.
- There should always be separate toilets and washing facilities for men and women. Some hospitals have separate wards.
- You can have visitors, but some hospitals only allow visitors at certain times.
- You might get medication, talking therapy and occupational therapy.
- Doctors will speak to you at ward rounds or meetings so they can decide what treatment you need and whether you need to stay in hospital.
- You will be able to wear your own clothes on the ward.
Going into hospital is called an admission. When you go into hospital, doctors might say that you have been admitted.
If you want to go into hospital
If you are unwell you may feel that you need treatment in hospital. If a doctor at the hospital agrees that you need to be in hospital they will admit you.
Many people agree to go to hospital themselves. Doctors call them voluntary patients. If you would like to be admitted as a voluntary patient, you can try the following.
- Speaking to someone in your Community Mental Health Team, if you have one. You may have a care-coordinator you can speak to.
- Contacting your local Crisis Team. You might be able to get their details from your GP surgery.
- Contacting your GP. There may also be an out-of-hours service.
- Going to the Accident and Emergency (A&E) department of a local hospital.
You might not be able to go into hospital even if you want to. It will depend on the number of beds available and if the doctors think you need to be there. If there are not enough free beds in your local hospital, staff could send you to a different hospital.
Detained under the Mental Health Act
There may be times when you are unwell but don’t realise it or don’t want help. When this happens doctors may say you lack insight. The Mental Health Act 1983 means doctors can force people to go to hospital if their illness puts them or other people at risk.
You might hear it being called:
- detained under the Mental Health Act,
- Mental Health Act admission, or
- involuntary admission.
These phrases mean the same thing.
What can I do to prepare for hospital?
Your home and things
You could ask someone to keep an on your home and feed your pets. This could be a friend, family member or carer. If you can’t do this, your local authority may have to keep an eye on your things.
The local authority must protect your property if it could get lost or damaged. This includes your home, furniture and pets. They might have to go into your home and move items into storage. They can only do this if you agree or someone who can make decisions for you agrees. The law says that the local authority can charge you for this.4 The policy on charging will vary from area to area. For example, some local authorities will pay for property storage or pet boarding if you have been detained.
If you are worried about your things when you are in hospital, you could try talking to:
- a friend, family member or neighbour,
- a social worker at the hospital,
- your local social services department,
- your care coordinator in the community, if you have one, or
- the Approved Mental Health Professional (AMHP), if you have been detained.
If you have children, you can arrange for them to stay with a friend or family member while you are in hospital. If this is not possible, contact your local authority and speak to children's social services about the situation.
If you get benefits, it is important to tell the Department for Work and Pensions (DWP) that you are in hospital. If you are not well enough to do this, then you can ask a carer or a member of the ward staff to tell the DWP. Some of your benefits might stop or reduce after 28 days. If you do not tell them the DWP may overpay you. If this happens you will have to pay the money back.
Taking things in If you go into hospital in an emergency, you might not have time to think about taking things in with you. If you don't take all the things you need, you could ask someone to bring things in for you. When you have time, think about taking in:
- extra clothes,
- night clothes,
- toiletries like body wash, shampoo, toothpaste, toothbrush, hair gel and make-up,
- some money, bring coins in case there is a pay phone on the ward,
- notepad and pen, and
- your mobile phone.
There should be a ward policy about mobile phones. Some hospitals ban them. Some wards also have restrictions on items such as razors, matches and lighters. Alcohol is not allowed in hospital. Some higher security wards have restrictions on alcoholic mouthwash, aerosols, glass containers, perfume, aftershave, dental floss and nail varnish remover. You should tell staff about any electrical items you have to make sure you are allowed to bring them in.
Try not to take valuable things such as jewellery or large amounts of money onto the ward. There may not be somewhere safe to keep them.
What is hospital like?
When you go into hospital, one of the nurses should ask you for your details. The hospital staff may be dressed in their own clothes or in a uniform. They should wear name badges.
If you have questions about your treatment or your rights, ask a nurse or your key worker on the ward.
There will be a routine on the ward. There will be regular meal times for breakfast, lunch and dinner. There may be a water machine or a kitchen to make hot drinks.
You cannot smoke on the ward. But, there may be outside areas where you can smoke. Depending on the building, a smoking area may be some way away from the ward. In some hospitals there are no smoking areas at all.
If you are in hospital under the Mental Health Act 1983, a member of staff may have to go with you when you want to smoke. If this is the case, then you might not be able to smoke as often as you would like.
Layout and rooms
In some hospitals you will have a room of your own. Other hospitals may have wards with a few beds in the same room. This is the same as other hospital wards you may have been on. They should not have men and women in the same room. There should always be separate toilets and bathrooms for men and women. In some cases you might have to go into a room with people who are not the same sex as you. If this happens the hospital will keep you separated from everyone else to give you privacy. The hospital should put you in a room with the same sex as soon as possible.
There should be an area where you can spend time away from your room during the day. This is called the common room or day room. These rooms may be for men and women. In some hospitals there are separate wards for men and women.
There should be a chaplaincy or spiritual care service that you can use. These services can be used by anybody of any faith, and by people who are not religious.
Observation on the ward
If staff are worried about you, they may put you on observation. This means that staff will watch over you to make sure that you are safe. For example, staff might check on you every hour or stay with you all the time.
Problems with other patients
If you have any problems with any of the other patients on the ward you should tell a member of staff straight away.
Searches on the ward
Staff may look through your belongings when you first go into hospital or when you return from leave. Staff might search you if they think you have something that is not allowed on the ward. They should ask for your permission before they search you.
The hospital should have a written policy on searches. If you are not happy with the way they are searching you, you could ask to see this policy.
If you are in hospital under the Mental Health Act 1983, staff can search your things without your consent. But if they do they should still:
- ask you first,
- ask your doctor if they don’t think agree, and
- give you a good reason why they need to do the search.
If you are under the Mental Health Act and there are good reasons the staff can search you at anytime. Some of these good reasons may be you have:
- brought things onto the ward you shouldn’t have,
- had drugs on the ward before,
- self harmed on the ward with something you hid in your bag, or
- don’t take your medication and hide it in your bag.
If the staff take any of your items they have to:
- tell you why they took it,
- tell you where they will keep it,
- tell you when they will give it back, and
- give you a receipt for them.
The hospital staff might want to search the people who visit you. This is more common in higher security hospitals and forensic unit wards. If your visitor does not want this to happen then they cannot force them. But they might not be able to see you or the visit may be supervised. This depends on the hospital's security policies.
Wards and treatment
What sort of ward will I be on?
There are different types of wards in mental health hospitals.
The first time you go into hospital you may go on an acute ward. The staff will assess you and give you treatment. There will be a mix of patients who are in hospital voluntarily and under the Mental Health Act 1983.
Psychiatric Intensive Care Unit (PICU)
This is a ward for people who are very unwell. PICU sounds like “P-Q”. You may be put on this ward if there is a concern you might be at risk of harming yourself or others.
Staff may move you to PICU from an acute ward, or you might go straight to PICU. There are more staff on this ward so they can give more support.
It is likely that the PICU ward will be locked, and most patients will be in hospital under the Mental Health Act 1983.
If you are in hospital, you may go to a rehabilitation ward to help you become more independent. It aims to prepare you for living in the community.
Staff may offer you might be offered talking treatments and occupational therapy to help with developing daily living skills. You will be offered more activity and less supervision here.
You may be admitted to a specialist ward. These may include:
- personality disorder units,
- eating disorder units,
- forensic units for offenders with mental illnesses,
- mother and baby units, and
- young person units. Children and young people should be in a ward that is suitable for people of their age. This would usually mean a unit with specially trained staff.
The availability of specialist wards varies from area to area. You need specialist care that local NHS services cannot give you, Your NHS may offer to transfer you to a hospital in another area.
What care and treatment will I get?
A psychiatrist will speak to you soon after you go into hospital. A psychiatrist is a specialist mental health doctor. The psychiatrist will decide what treatment you need when you are in hospital. You might give you medication or say you should speak to a therapist.
They might offer you occupational therapy. Occupational therapists help you to learn how to deal with difficulties with everyday tasks to be independent. This might involve cooking classes or managing bills.
In some hospitals there are creative activity groups or they bring in pets as part of a therapy session. These will be different from ward to ward, and not all hospitals can offer this. Speak to a member of staff on your ward to see if they have any activities you can take part in.
The staff at the hospital should do weekly ward rounds. Ward rounds are when staff members meet with you to see how your treatment is going and if it needs to change. People on the ward round might be your psychiatrist, nurse, psychologist or occupational therapist.
You might want to ask some questions like these.
- Can you explain my diagnosis or treatment?
- Will my medication cause side effects?
- How can I cope with side effects?
- What other medications might work for me?
- Will I have talking therapy in hospital?
- Do you think my symptoms might be caused by physical illness?
- How often will you see me?
If you have any problems with the care you are getting in hospital, then you may want to contact an advocate. An advocate is someone who does not work for the NHS and who might be able to help you with any problems with your care. If you are in hospital under the Mental Health Act 1983 you are entitled to see an Independent Mental Health Advocate (or IMHA). Ward staff should have details of the IMHA service that covers your ward.
If you are a voluntary patient, you are not entitled to see an IMHA. But there may be a general advocacy service in the area that can help.
Can I see family and friends?
You can have visitors if you want. Some wards have fixed visiting hours and others allow visiting at any time. Your friends or family can find out about visiting from the staff on the ward. If you have visitors, you could ask to use a private room rather than sitting in the dayroom with other people.
You can ask visitors to bring things to the hospital that you might have forgotten. Your visitors may be able to bring in food and drink for you.
There may be things that visitors are not allowed to bring into the ward such as sharp items, drugs, alcohol, matches and lighters. Your visitors can get information about what they are not allowed to bring from ward staff.
You may find visits stressful, depending on how you are feeling. If this is the case, you may prefer visits to be shorter, or less often. If you do not want visitors at all, then you do not have to see anyone. Tell a nurse or your doctor if you are not happy with the visiting arrangements.
Can I leave?
You can leave hospital unless you are under the Mental Health Act 1983.
You are a voluntary patient if you are not in hospital under the Mental Health Act 1983.
You can leave hospital if you want and you do not have to come back. If you don't want to come back, it is best to tell a member of staff.
You can go on your own or with visitors. If you are leaving for a while, ward staff may ask you to come back by a certain time.
If you are on a locked ward, a member of staff will need to open the door for you to leave. They have to open the door for you unless you are detained under the Mental Health Act.
If you try to leave but a doctor thinks you are not well enough to leave, they can keep you in hospital for up to 72 hours in an emergency. A nurse can also do this for up to 6 hours. They should only do this if it is needed because you are very unwell.
If you are detained under the Mental Health Act 1983
If you are detained, you cannot leave the ward unless the doctor in charge of your care agrees. This doctor is called your responsible clinician (RC).
If your RC is happy for you to leave the ward for a short time, this is called section 17 leave, or sometimes it is just called leave. You might be able to leave by yourself. This is called unescorted leave. Your doctor might think it is better for you to leave with a member of staff, and this is called escorted leave. You might also be able to go on leave with a relative, and this is called accompanied leave.
If you think you should be getting more leave, talk to your RC about this. You may want help from a friend or relative, or perhaps an advocate.
You can see an advocate called an Independent Mental Health Advocate (IMHA). They can help you to get your views across to staff at the hospital. The ward staff should be able to let you know how to contact an IMHA if you would like one.
You can only leave if you are not detained any more.
Deprivation of Liberty Safeguards (DoLS)
Hospital staff can sometimes keep you in hospital under ‘deprivation of liberty safeguards’ (DoLS). They can only do this if you cannot make decisions for yourself and it is in your best interests. For this reason, it is not used for people with a mental illness often. It is different to the Mental Health Act. It is more common for people with dementia or learning disabilities.
If the doctors think you should leave
When you are well enough to leave, the doctors will say that you are ready to be discharged.
The hospital staff might ask you to go to meetings to talk about what will happen when you leave. This might be called a discharge meeting or a pre-discharge meeting.
This meeting would involve:
- your care team in hospital, and
- any staff from community mental health services who will support you when you leave hospital.
Your carer can be involved if you want. These meetings are to make sure that you have the support you need when you leave hospital.
Getting help from my carer
You might want a carer to:
- help you to remember information,
- help you raise concerns, or
- give you some support.
It is much easier for your carer to do these things if you tell staff that it’s OK. If you don’t talk to staff about it, they will not help your carer to do these things for you.
Your carer does cannot know information about your care unless you want them to know. This is because the hospital staff have to protect your confidentiality. If you want your carer to have this information, you should tell staff and they can put a note on your record. You could sign a consent for and give it to staff if you think this is easier.
You may feel comfortable with your carer being told some things but not others. This is up to you. Make sure you tell the staff exactly what you want to happen.
You can find more information about ‘Confidentiality’ at www.rethink.org.