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MIT Students' Frequently Asked Questions about Mental Health Services (MHS)
FAQ Major Topics:
Mental Health Hospitalization
How often are students hospitalized for mental health issues?
Mental health hospitalizations are unusual at MIT, and result only from careful assessment of the student and his or her supportive environment. There were more than 11,000 visits to MHS by students in academic year 2003-2004; only 24 of those resulted in hospitalizations. Most of those hospitalizations were voluntary: the patient agreed that he or she was at risk and would benefit from intensive treatment.
When is someone hospitalized involuntarily?
In the Commonwealth of Massachusetts , a person can be hospitalized involuntarily only if the person requires hospitalization so as to avoid the likelihood of serious harm to self or others. To assess risk, the clinician uses his or her clinical judgment to weigh a variety of factors, such as the individual's current situation, past history, and mental status. For example, an individual who currently exhibits signs of depression, has previously attempted suicide, has a specific suicide plan, is intoxicated, or has a history of not being able to control violent impulses would be considered at higher risk. Clinicians also consider factors that reduce an individual's risk, such as the availability of social supports. But the bottom line must always be the individual's safety and the safety of others.
What is meant by social supports?
Social supports refers to all people and services who are available to the student and engaged by the student to help with the difficulties the student is experiencing. This most often includes family, friends, significant relationships, faculty advisors, Housemasters, GRTs, mental health professionals, and clergy.
How is a mental health hospitalization alike and different from a hospitalization for a physical health concern?
There are many ways that medical and psychiatric hospitalizations are similar. The purpose of both is to provide more intensive treatment and monitoring than can be provided at home. The hospital environment is set up with safety and treatment as the first priority and a patient does not have easy access to all of the things that one is used to at home. In a psychiatric hospital, intensive treatment means that the patient is observed closely: the actual level of supervision varies according to the staff's assessment of the patient's level of risk for destructive behavior. The most closely observed status is one-to-one, where the patient is observed continuously by a staff person. The least observed status is when the patient is able to move freely around the hospital unit.
Can patients in psychiatric hospitals use cellphones and check e-mail?
Access to phone and internet is a problem in hospitals. The basic philosophy is usually that the person is there for treatment and other activities should not interfere with this work. On the other hand it is also recognized that preserving contact with the outside world is important for a person's mental health particularly for a student. Each inpatient unit has its own policies about the use of phone and internet and some can make special arrangements. However, most places are not set up with resources such as WiFi and broadband access.
What about visitors?
Most inpatient units have specified visiting hours and will receive visitors for a patient on condition that the patient says that he or she wants to see those visitors. Generally, visiting hours are designated to avoid interruption of treatment sessions, so it is usually best to determine the visiting hours before arriving at the hospital. The hospital's emphasis is on treatment and visitors that arrive during times that the patient is receiving group or individual therapy may not be able to visit until the therapy session is finished.
How long is a mental health hospitalization?
Lengths of stay vary considerably extending from 1 or 2 days to several weeks. Usually the severity of the illness, participation in treatment, and the amount of insight that a person has are the most important determinants of the length of stay. Most hospitals have an average length of stay of under a week.
Since a hospitalization interrupts the patient's usual life and routines, the stay is kept as short as possible. On the other hand the staff wants to be sure that there is not a large risk for violent or self-destructive behavior if the patient is discharged. There usually are two simultaneous assessments: one of the patient's mental status and how it is improving since admission, and another of the situation into which the patient is being discharged. If the patient is feeling better and the staff determine that there is a safe situation with appropriate treatment, then the patient can be discharged.
Who decides when a patient can leave the hospital?
Like the decision to be discharged from a medical unit, the decision about when to discharge a patient from a psychiatric unit usually involves a number of factors and a number of people. The attending psychiatrist in the inpatient unit has the final word, but the decision is usually made in consultation with the rest of the inpatient team and the outpatient treators. MIT mental health clinicians will have input and can provide important information about the kind of community supports that are available to MIT students. A patient is discharged when the staff's assessment is that the patient can live safely in his or her home environment and can receive the treatment that he or she needs. In the case of an MIT student, community factors also play a role: sometimes the impact of the student's behavior and state of mind on his or her living group has to be considered.
Sometimes, a student may no longer require a hospital setting to maintain his or her safety, but may still need a level of support that exceeds that which is possible in a residential university environment. In this situation, a withdrawal for medical reasons may be discussed to allow for a more extended period of recuperation.
I have been hospitalized and I don't think I need to be here. What do I do?
There are many means of recourse if you feel that you have been hospitalized unjustly. These range from negotiating with the attending physician for discharge to taking some form of legal action. Every hospital is required to have a human rights officer who can help to mediate these kinds of discussions.
Even though it may have been the staff at MIT who initiated the hospitalization, it is the staff at the hospital that makes the decision about discharge. The first step is for you to find out who are the members of your treatment team and to discuss the situation with them. In most hospitals every patient will have a person who acts as his or her main contact with the treatment team; this contact is often called a case manager or primary clinician. Explain that you are not a danger to yourself or others and that they can check with whomever they need to verify this.
The vast majority of disagreements about discharge are resolved through negotiation with the treatment team. If this is not effective you can request to speak to a human rights officer, or you can refuse to sign into the hospital (if you have already signed in, you can sign a 3-day letter of intent to leave). Either of these actions starts a legal process which will result in discharge unless the hospital applies for a court hearing to keep you against your will.
Leaving the hospital earlier than the staff recommends does not mean that you may immediately return to school. That is a separate decision that is made after conversations with the hospital staff, student support services, and MIT Mental Health.
How can I help a friend who is hospitalized?
Many people who are in the hospital appreciate visitors. Some people may feel like having more privacy at the start of a hospitalization but have interest in more contact as time goes by. There is such a stigma attached to psychiatric hospitalization that people who have been hospitalized are often afraid that their friends don't want to be around them. The most important thing that you can do is be supportive and to stay in touch. You might offer to bring them things that they need, such as shampoo and problem sets.
Who can I talk to if I have questions about a friend or room-mate's hospitalization?
In order to find out specifics about how a person is doing or what happened, it is best to speak directly with that person, or to ask for a meeting with a staff member and your friend. It is usually best not to have meetings with staff without having your friend or roommate present, as your friend may not want to be "talked about" without his or her presence. Hospital staff are bound by federal and state law and hospital policy to safeguard patient's confidentiality. They would need the patient's permission to share any information with you.
For general information about psychiatric hospitals and psychiatric illnesses, you can talk to anyone in MHS either by coming to walk-in or scheduling an intake.
What if I have more questions?
It is usually best to talk to the staff at the hospital where your friend is staying. However, most hospitals are very careful not to give out information about a patient without the patient's permission, so it can take some time for the staff to get back to you. MHS staff and counseling deans also cannot give out any information without the student's permission. Often someone such as a housemaster will have discussed with the student what information he or she would like to have conveyed to their friends, and can give out that information when asked.
The above was prepared by the mental health work group of the MIT Student Health Advisory Council with input from the staff of the mental health service at MIT Medical. This source should be acknowledged if the material is used.
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