Hospitalization

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• General Considerations

• Involuntary Inpatient Admissions
• What to Expect After a Sailor is Hospitalized
• Post-Hospitalization Concerns and Opportunities for Support
• Working with the Mental Health Provider

GENERAL CONSIDERATIONS

Psychiatric hospitalizations are appropriate when distressed Sailors necessitate intensive mental health treatment in a safe and stable environment. This intervention is at times necessary to promote safety of the service member and of others, to significantly improve their psychological health, and to potentially maintain a career with the armed services.

A psychiatric hospitalization may be necessary when a Sailor, at whatever age or rank, is found to be a danger to self or others. Psychiatric hospitalizations can provide Sailors with a secure environment for monitoring their safety and providing intensive and rapid treatment. Usually, the decision to hospitalize is a voluntary and joint decision between the patient and the provider. In certain situations, however, a Sailor may be involuntarily hospitalized if in good clinical faith he/she is believed to be an imminent threat to self or to others, is unable to care for his/her own needs in the case of a serious mental disorder, and/or cannot be treated safely in a less restrictive environment. Once the Sailor's condition improves, treatment can continue on an outpatient basis.

Treatment provided during psychiatric hospitalizations may include the use of medications and individual/group counseling aimed at the use of more adaptive behaviors for coping with life stressor and their condition. Adherence to the ongoing treatment plan is essential for their progress. Support from the Sailor as well as family members is also crucial for recovery. Unit leaders can contact the hospital staff to help determine appropriate support. Once stability is reached, the Sailor is discharged and the person can begin to focus again on his/her work responsibilities.

RELEVANT POLICY

INVOLUNTARY INPATIENT ADMISSIONS

Members will be admitted for involuntary inpatient psychiatric treatment only when outpatient treatment is not appropriate, they present a danger to themselves or others, and they do not consent to voluntary inpatient treatment. (see SECNAVINST 6320.24a)

• Only a qualified doctoral level mental health provider with psychiatric admission privileges may involuntarily hospitalize a service member. Involuntary hospitalization should be based on the reasonable and sound clinical judgment of the provider.
• The service member will be evaluated within 24 hours to determine if the involuntary admission was warranted and if the service member continues to require hospitalization. The Sailor will be notified verbally and in writing of the results of this evaluation.
• An independent review of the involuntary admission will occur within 72 hours to determine whether the referral and admission were appropriate. If insufficient cause for holding the Sailor is found, the member will be released from the hospital.
• In addition, service members involuntarily admitted for treatment are afforded the following rights:
  • To be informed of the reasons for and consequences of the involuntary psychiatric admission.
  • To contact a friend, relative, chaplain, attorney, and/or the Inspector General (IG) as condition permit such communication.

WHAT TO EXPECT DURING HOSPITALIZATION

As most psychiatric hospitalizations are not planned in advance, the Sailor will likely be unprepared to spend time in the hospital. Helping the person obtain items from his or her home will be helpful and these items may include changes of clothes and items for personal hygiene. Sailors may be hospitalized for a day or several days, depending on how rapidly progress is made. This effort may also be coordinated with family members.

• While hospitalized, the Sailor will be regularly evaluated for potential harm to self or others.
• The Sailor is expected to participate with treatment during his/her stay (e.g., prescribed medications, regular attendance and active participation in group therapy).
• When the person is no longer deemed a danger to self/others, plans will be made for discharge.
• Optimally, discharge planning will be coordinated between all involved groups (e.g., the treatment team, service member, and service member's command).
• Regular contact with the sailor after the hospitalization can be helpful both for monitoring the person's status and in sending the important message that the member is valued.
• If the member carries a weapon or works in a critical area, it is suggested that he/she seek recommendations from a mental health provider regarding duty limitations and necessary accommodations.

POST-HOSPITALIZATION CONCERNS AND OPPORTUNITIES FOR SUPPORT

Although the Sailor's emotional and behavioral symptoms and immediate risk for suicide or homicide may have lessened during the hospitalization, problems with distress and risk-taking behaviors may persist. Significant stressors that existed prior to hospitalization may continue following discharge from the hospital and may trigger a relapse. These stressors could include a lack of social support, changes in life circumstances, legal problems, financial problems, and problems in relationships. The member should be reevaluated by a mental health provider if they display new or worsening signs of distress after discharge. Leaders need to work closely with the mental health provider to develop and implement a plan to monitor and help the Sailor.

It is important to ensure that the command knows when their personnel are released from the hospital. The command can encourage and offer assistance as needed (e.g., setting appointments or providing transportation) for Sailors to attend follow-up appointments with the mental health provider shortly after discharge for reevaluation and treatment

Other considerations following hospitalization involve determination of whether the service member will be able to meet the demands of full active duty status considering the recommendations set by the mental health provider. Possible dispositional outcomes may consist of recommendation for administrative separation based on suitability for duty or placement on limited duty for time to recover or with the potential for receiving a medical board evaluation. Certain mental health disorders and/or treatment interventions (e.g., specific classes of medication) may disqualify a service member from caring small arms (see page 4 of OPNAVINST 3591.1F) or having access to classified information. Although the concern of one's future in the Navy may be a deterrent for some to seek mental health services, it is essential that the Sailor's leadership consult with a mental health provider if concern for safety exists

WORKING WITH THE MENTAL HEALTH PROVIDER

Occasionally leaders may become frustrated after a service member becomes hospitalized. They have understandable concerns regarding the Sailors "stability" and ability to perform their job. There may be lingering concerns of danger to self or others. These concerns can be addressed by:

• Re-evaluation with a mental health provider shortly after discharge from the inpatient facility.
• Referral to the Military Treatment Facility (MTF) Emergency Department if there are signs of worsening in the service member's condition occurs during non-duty hours. Any worsening of the individual's condition should be communicated to the mental health provider.
• Regular conversations with the Sailor to ensure that he/she is a valued member of the command.
• Immediate communication with the Mental health Department or Emergency Department if there is safety concerns.
• Documenting any problem behaviors observed by Sailors who know the distressed individual.

REFERENCES

• Bourgeois, J. A., Chozinski, J. P., Walker, D. M., Orr, K., & Wisniewski, W. (2001). Psychiatric treatment and operational readiness: clinical guidelines for Air Force Practice, Military Medicine, 166, 378-81.
• Manos, G. H., Carlton, J. R., Kolm, P., Arguello, J. C., Alfonso, B. R., & Ho, A. P. (2002). Crisis intervention in a military population: A comparison of inpatient hospitalization and a day treatment program. Military Medicine, 167, 821-5
• SECNAVINST 6320.24a
• DoD Directive 6490.1
• DoD Instruction 6490.4

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