Each inpatient unit/ward or hospital is structured somewhat differently. But the overall approach is of a multi-disciplinary treatment team that consists of a doctor (MD or DO), nurses, a social worker, therapists (possibly occupational therapists, art therapists, and recreational therapists), aides, and possibly a psychologist. It is common for a patient to be assigned a daily contact person, or primary clinician, to help coordinate his overall care.
With inpatient hospital stays being quite brief, the goal is to rapidly stabilize the person’s symptoms in a safe environment. If the person is in a manic or mixed state, stabilization is usually achieved through the use of tranquilizing and sedating medications combined with a mood stabilizer such as lithium, lamotrigine or valproate.
Typically, medications to regulate sleep will also be made available. In all of the mood states a good night’s sleep can be helpful in moving things in the right direction.
For a person who is severely depressed, treatments might include mood stabilizing medication, antipsychotic medication if psychosis is present, and possibly an anti-depressant.
In situations where the depression, mania, or mixed episode is severe and not responding to medication, electroconvulsive therapy (ECT) might be considered.
Apart from medications and the secure setting, inpatient treatment teams will also work quickly to address major stressors (marital conflict, financial problems, lack of insurance, legal issues, etc.) and pull together discharge plans so that the treatment initiated in the hospital has the greatest possibility of being continued in a less restrictive community setting. This connection to outpatient care, discharge planning, is crucial.
For family, getting acquainted with the treatment team is important. As there are many rules around confidentiality, one step that needs to happen early in the admission is for the patient to agree to have his family and/or significant other be allowed to participate in treatment. This is done through the signing of a form (Release of Information) that gives hospital staff permission to talk to the designated people.
When a patient is determined to no longer be at imminent risk of harming himself or others and to be able to provide for his basic needs in a less-restrictive setting, he will be discharged. Typical next steps in treatment may include:
• Partial hospital programs
• Intensive outpatient programs
• Private psychiatrists and therapists
• Outpatient clinics