PMADs and the ER: What Happens When You Go to the ER?

Part 2 of 4 in a series of posts by nurse and counselor Amber Thiessen. Part 1 covers when to go to the ER, part 2 talks about what to expect when you go to the ER.

What Happens at the ER?

Coming to the ER doesn’t necessarily mean you will be admitted to a psych ward.

I think that’s a common fear women have. As health care professionals, we do take postpartum depression very seriously because there are so many stressors moving into motherhood and without supports in place it can deteriorate quickly. This isn’t intended to scare you; it’s simply the reason why it’s important to seek treatment.

The stats show that while 1 in 4 women experience postpartum depression, at most 2 in 1,000 will experience postpartum psychosis. This tells us it’s not a common occurrence, but it is possible and something we want to prevent. In my eighteen years of nursing, I have seen this a handful of times. Thankfully, psychosis is treatable with medications and our patients improve, often quickly with intervention.

Please remember, we know you are doing the best you can, by seeking help, you are doing what’s best for your family, including your baby.

What to expect when coming to the ER

I’d recommend bringing someone with you. If you’re acutely distressed, having someone with you can help as they can act as your initial spokesperson. Often, there’s a long wait in the ER, but if your baby and spouse can come and sit with you, this may help with the anxious feelings, particularly if you’re breastfeeding and concerned about schedules.

However, sometimes having your baby there may not be best. Perhaps the reminder of the guilt and shame you feel is increasing your panic. If you’re bottle feeding and have someone who can watch them for a while, this could be a better plan for you.

When you come to the emergency department, first you’re going to be registered and triaged. The triage nurse usually understands mental health concerns and won’t ask you too many invasive questions, but they will ask about suicidality in order to assess risks while you are waiting to be seen. Try not to be offended with the questions; they’re just trying to do their job and keep you and others safe.

Then you’ll likely have a waiting time. Some ER’s have a mental health or psychiatric liaison nurse who specializes in mental health assessments. They are the bridge between the ER doctors and mental health resources, including psychiatry. The nurse may have other patients at the moment, so be prepared to wait. Bring music, a coloring book, even something to watch on your phone—activities to help you pass the time.

Next is the mental health assessment. When you meet the mental health nurse for the interview, there are a lot of questions. We have a short window to get to know you and the situation as best we can to streamline the resources available to best help you. The interview is also a way we interact and demonstrate empathy and care for you. We want to get a picture of your life, family, work, symptoms, physical health, and mental health history.

During the interview, we’re going to ask about your goals and expectations. It’s helpful to be clear on why you’re there and what you feel you need help with. Sometimes when you’re in crisis, you may not know exactly what you need but more often it’s just to feel better. We work together to make a plan to keep you and your family safe and talk about how to get you to where you want to be.

Whether it’s a consultation with psychiatry, a referral to a crisis unit, medications, or providing you resources to take home, we work together with you to create a plan to move you closer to improved health.

What the ER Can Provide

Community resources. If you’ve moved to a new community or this is your first encounter with mental health struggles, and you’re in crisis, they will be well-equipped to offer you phone numbers, counseling options, and support groups where you can plug-in and find support. These may also be accessible with a few phone calls, but will be provided when you come in.

A crisis stabilization unit. This is not a hospital but a center where you stay for a few days to give you distance from normal life and provide immediate counseling supports. They may also provide an opportunity to meet with a psychiatrist for an assessment. A unit like this is helpful because the list for a counselor in the community is long, and when you’re in crisis, having a trained listener is a valuable support to guide you through your situation. It also provides a safe place while the crisis fades.

However, in my experience, this is often the most difficult for postpartum moms because staying away from their baby can cause more stress, guilt, and fear. It’s up to you whether this is a good choice, and if this is an option for you, that’s great. In some areas there is a virtual option available where the crisis practitioners meet with you a few times throughout the day, via zoom or phone call, which could be a more appropriate alternative.

Medications for acute distress. If you’ve been on a mental health journey for a while, you may know that most antianxiety and antidepressants don’t work immediately, taking 2-6 weeks before you start to notice a difference. In some cases, short acting medications can be used, but these won’t be prescribed for you to take home.

Psychiatry Referral. This isn’t guaranteed when you come to the ER. You may or may not see a psychiatrist. The benefit is speaking with a specialist who can guide your care, medications, and treatment plan. Speak to your family doctor for a referral if you live in Canada.

What the ER Cannot Provide

Biblical counseling. Your mental health care provider may be a Christian, but they may not. During the interview, they will engage with you about how spirituality impacts your life so you can feel free to share. They will likely be able to direct you to faith-based supports or resources available, but it won’t be similar to a visit with your pastor because they may or may not share your faith.

Practical helps. Skills and strategies for coping are best learned in relationship with a counselor. The regularity of seeing a therapist provides accountability and ongoing conversation about your growth and progress. The ER is not designed for this; we’re more like a gateway to help you take next steps.

For everything to be better today. As Christians, we believe that healing comes through our relationship with Christ and that he does actively heal today. But God is also sovereign and you may or may not be healed immediately. In speaking with a trained listener, often times you can notice relief and improved mood because someone understands and empathizes with what you’re going through. It’s helpful to think of this season as one leg of your journey and the visit to the ER as a piece of the growth that can continue to happen.