Most often when we think of someone being in the hospital, we think instantly of their physical health. However, mental health can play an important role in healing physical issues as well. The mental health aspect of healthcare, when it comes to physical maladies is often overlooked, or simply not thought of as often as it should be. I am a firm believer that every patient who has been admitted to the hospital should receive, at the very least, a cursory mental health examination. By doing so, properly trained staff may well be able to predict the need for further psychological or even psychiatric interventions.
This cursory exam should be performed on each and every patient who is admitted to the hospital, to identify potential concerns. This should apply even if the patient is entering the hospital for a seemingly simple procedure or even something that may be as considered as routine as giving birth. Whether the patient is a veteran like myself, with maybe a new and unfamiliar medical condition, or a relatively healthy person who has experienced a life-altering medical or trauma related incident that has led them to the hospital. Either of these patients can experience many forms of anxiety which can manifest itself as anger towards others including staff, and by the untrained professional caregiver be considered as non-compliant or even belligerent, when all they truly are is scared and anxious of the unknown.
I have personally once been prematurely discharged from the hospital by what I deem to be an improperly trained resident who had convinced his attending that I was being belligerent and argumentative. In reality I was suffering the well documented effects some people experience from steroid medications, nicknamed “roid rage” in the medical community. It is so aptly named because the patient becomes argumentative, belligerent, and occasionally even physically violent on steroid medications. While I partially blame this on inadequate training of the resident managing my case. I further blame it on inadequate oversight and supervision of the resident by his direct superior who signed off on my discharge without ascertaining all the facts for themselves.
By having and properly utilizing mental health services, you can prevent unnecessary “labels” such as non-compliant and belligerent from being applied to patients which carry their own risk of further using or heightening anxiety. By making the appropriate mental health referrals, you can not only reduce the stress a patient may encounter, but improve their physical recovery as it has been well documented over time that mental health can most definitely affect physical health in a variety of ways. Emotional distress can manifest itself into physical symptoms which in turn could easily complicate proper diagnosis and treatment of a patient, especially if the providers have not considered the patients mental and emotional health appropriately.
To someone with a major or even relatively minor illness that requires hospitalization, and this is their first ever encounter with the inpatient aspect of healthcare, the experience can be quite stressful. The issues one may feel range from depression over the source of their admission, especially if it will be a long term illness or recovery, to loss of control over their own life and care, to anger (why did this happen to me), feelings of loss, or any range of emotions. It is important to realize that the first time patient, has absolutely no idea what to expect when admitted to the hospital. And realistically, most often staff themselves are too busy to explain each step of the way what the new patient may expect.
Even a veteran patient like myself, can find themselves feeling similar anxieties despite being sometimes intimately familiar with what to expect. Maybe the reason for this admission is different than precious ones, or you have a different physician with whom you do not have your normal rapport. Or maybe you are simply anxious over the unknowns of being hospitalized despite having been through it before. Maybe you are facing a potentially lengthy recovery that will require admission to a physical rehabilitation facility or even to a skilled nursing facility, often referred to as nursing homes. While skilled nursing facilities are often also utilized for short and sometimes even long term physical rehabilitation, the stigma associated with the term “nursing home” may well cause further anxiety, and yes even fear in a patient. These items need to be addressed before they further complicate the patient’s recovery.
Not only is it perfectly okay to feel this way, but it is also entirely normal for some people to be more susceptible to the stressors of being hospitalized in an inpatient setting. This does not imply weakness of either mind or body, rather it indicates that you are reacting normally to a stressful situation of which you have little to no control, or even any idea what will happen next. One in which it is often not explained to you on an ongoing and consistent basis what is going on with your care.
More than once, I’ve had a transport aide arrive at my room to inform me that they are there to take me for <insert random medical test here>, when I had no clue that such a test had been ordered, let alone even considered to be necessary by my medical team. Sadly this has become the norm. Patients in ICU often experience even more severe anxiety than those on a regular floor. Between the severity of their particular health condition, the unfamiliar surroundings, the and the unusually naturally stressful environment of the ICU itself, are all stressors to even the most experienced patients, as I myself can attest to having recently awakened on a ventilator when that was not expected in the least.
I’m not saying every patient who gets admitted to the hospital should be placed on anti-depressants or other mental health medications or treatments. What I am advocating, is that everyone involved in the patient care team pay attention for the warning signs of some of the aforementioned stressors that can also contribute to depression on a more long term basis if not addressed properly in the first place. Often an outburst by an otherwise very pleasant patient is a sign of something lurking below the surface such as anxiety, or even confusion over their healthcare.
As previously stated, a routine mental health screening wouldn’t be a bad idea to determine those patients who may be more susceptible to the above issues, or even those who may already be experiencing them, but are afraid to admit it for fear of feeling or being labeled as crazy. Mental health should be a part of every patients care management team, for both their own health as well as staff safety. If you have a patient who is feeling overwhelmed who may lash out, this then become an important safety issue for not only the patient but also facility staff.
During a recently particularly stressful day, and a relatively sleepless night due to that stress, despite being totally unrelated to my hospital admission, I was in a really sensitive and even downright bad and cranky mood. An innocent comment made to me by a staff member that I took out of context, led me to verbally lash out at this staff member. Thankfully this staff member was very familiar with me and new that this was way out of context of my normal demeanor. Rather than simply lash out in return to my outburst, she took the time to speak with me, and determine the real cause of my demeanor change. When all was said and done, things ended on a relatively positive and upbeat note. The particular staff member realized that right then was not the time to “push” me into the scheduled treatment, and graciously agreed to give me time to collect my thoughts and myself, in order to better face the day ahead. Further she agreed to make accommodations in her very hectic schedule to permit me to make up that treatment.
In closing, if you or a loved one finds yourself as an inpatient, be sure to be aware of the potential stressors that could further aggravate your health and your recovery. Don’t be afraid to reach out for an evaluation, or treatment if necessary. It is not an admission of weakness. Quite the contrary it is an admission of strength enough to know your body well enough to know it’s own limits, and to know when to ask for help!