- When Should You Go to the Hospital for Severe Depression?
- When Should You Seek Psychiatric Treatment at the Emergency Room?
- Hotline Information
- Understanding Hospitalization for Mental Health
- When do I need to go to the hospital?
- How can hospitalization help?
- Your time in the hospital
- Wellness after hospitalization
- How can I find people who understand?
- How can I be prepared for a crisis in the future?
- How can an advance directive or a medical power of attorney help me?
- Do I need to go to the hospital?
- What other options do I have?
- Who decides whether or not I’ll go to the hospital?
- When Should You Consider Hospitalization for Depression?
- Finding a Hospital
- Before or During Check-in
- During the Stay
- When Leaving the Hospital
- What Are Your Rights Regarding Hospitalization for Depression?
When Should You Go to the Hospital for Severe Depression?
Knowing when to commit yourself or a loved one to the hospital to be treated for severe depression can be a very gray matter. I wish there was a set of directions much like those when you are in labor: if contractions come within five minutes of each other and last a minute long, pack your bags. Some physicians will make the decision for you, but usually it is up to you. Here are few guidelines.
1. When you are in danger of hurting yourself or someone else.
If you are very suicidal and have gone as far as making plans, you should be in a safe place where you don’t have to rely on sheer willpower, because all of us who have experienced severe depression know that will power eventually caves. The pain is just too intense. Likewise if you are with young children or other people you could harm in a fit of rage, if you don’t have full control over your emotions, you should admit yourself into the hospital.
2. When you need to be treated aggressively.
You can be treated more aggressively in the hospital because of the close monitoring. Your doctor can change meds–try new combinations, etc.—in a fashion that would take weeks or even months with outpatient care. Because the support staff offers round-the-clock care, any unfavorable reactions of drugs are caught immediately. This can give your recovery a much-needed jumpstart.
3. When you need ECT treatments.
Electroconvulsive therapy is a form of neurostimulation therapy that has a high success rate for treating persons with severe and chronic cases of depression, especially those that have failed to respond to medication and psychotherapy. ECT involves applying electrical pulses to the scalp to induce seizures throughout the brain while a person is under general anesthesia. The procedure is usually performed inpatient because you can recover from the anesthesia in a safe environment and your doctor can closely monitor your progress.
4. When you can’t function.
If you can’t stop sobbing at work, in front of your kids, and have little control over your emotions, in general, you should consider hospitalization. If you can’t eat or sleep, shower or get dressed, the bare minimum tasks of functioning as an independent human being, you may be better off in a place where people can care for you.
When Should You Seek Psychiatric Treatment at the Emergency Room?
By Kayt Sukel
When her daughter, Jessica, decided to drop out of college, Carolyn thought she might just need a break from the stress of school. But once Jessica moved back home, Carolyn became alarmed. Jessica barely left her room. She wasn’t eating—and never seemed to sleep. She was listless and hard to reach. After a few weeks, Carolyn worried that Jessica was suffering from depression. She decided it was time to get Jessica some help. But, to do so, should she take her to the emergency room?
Jeremy Finkelstein, Director of Emergency Services at Houston Methodist Hospital, says whether or not you should take someone you think is suffering from depression to the ER for treatment is a common question.
“What people don’t understand is that mental healthcare is a severely rationed service, for many reasons. So there is a dearth of facilities providing comprehensive inpatient care,” he says. “Even in large cities, there are often only a handful of psychiatric facilities. So there are some pretty specific criteria required to get admitted to a hospital for psychiatric care.”
But, that said, an emergency room is often the place that provides the medical screening exam that can help a patient gain admittance to a mental health facility for treatment when needed. It can be an important part of getting that inpatient care when it is merited.
So when should you go to the emergency department? In Carolyn’s case, Finkelstein says that Jessica’s depression would constitute a psychiatric emergency if she is obviously suicidal or homicidal, telling people she is planning to self-harm or harm others.
“Self-harm, suicidal or homicidal thoughts are very clear-cut cases where you should go to the emergency room. And if you are experiencing severe physical manifestations of a mental health condition, anything that is a threat to bodily function or well-being, that’s a good time to go, too,” he says. “Sometimes what looks like a mental health problem is actually a medical one. And we can help with that.”
If a person is showing signs of psychosis, with severely impaired thinking or disorganized speech, Finkelstein says the ER is the right place. And if someone has already been diagnosed with a psychiatric condition and is having serious issues with medications, that’s a time to head to the emergency department, too.
“Situations that are life or limb threatening, that’s when it’s appropriate to go to the ER,” he says. “A lot of folks come to the ER telling me they are suffering from different life stressors, maybe someone lost a job, or someone’s girlfriend left him, and they feel depressed. But the high risk elements just aren’t there. And they won’t end up as an inpatient. In those cases, you are better off trying to find someone you can see on an outpatient basis.”
The information on this website is provided as a general information resource only, and is not a substitute for professional medical advice, diagnosis, or treatment from a qualified healthcare provider. Always seek the advice of your physician or qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of any information on this website. If you think you may have a medical emergency, call your healthcare provider or dial 911 immediately. The information on this website is provided “as is”. Assurex Health makes no representations or warranties, express or implied, regarding the information on this website.
Understanding Hospitalization for Mental Health
If you have severe symptoms of an illness like depression or bipolar disorder, a brief stay in the hospital can help you stabilize. This brochure is intended to help you through your hospitalization. Some ideas may be useful to you; some may not. Everyone’s experience in the hospital is different. Use only the suggestions that make sense to you and help you.
When do I need to go to the hospital?
You might need to go to the hospital if you:
- Are seeing or hearing things (hallucinations)
- Have bizarre or paranoid ideas (delusions)
- Have thoughts of hurting yourself or others
- Are thinking or talking too fast, or jumping from topic to topic and not making sense
- Feel too exhausted or depressed to get out of bed or take care of yourself or your family
- Have problems with alcohol or substances
- Have not eaten or slept for several days
- Have tried outpatient treatment (therapy, medication and support) and still have symptoms that interfere with your life
- Need to make a major change in your treatment or medication under the close supervision of your doctor
How can hospitalization help?
- The hospital is a safe place where you can begin to get well. It is a place to get away from the stresses that may be worsening your mood disorder symptoms. No one outside the family needs to be told about your hospitalization.
- You can work with professionals to stabilize your severe symptoms, keep yourself safe and learn new ways to cope with your illness.
- You can talk about traumatic experiences and explore your thoughts, ideas and feelings.
- You can learn more about events, people or situations that may trigger your manic or depressive episodes and how to cope with or avoid them.
- You may find a new treatment or combination of treatments that helps you.
What do I need to know about the hospital?
- Hospitalization is intended to create a safe place to allow severe symptoms to pass and medication to be adjusted and stabilized. It is not punishment and it is nothing to be ashamed of.
- You may be on a locked ward. At first, you may not be able to leave the ward. Later, you may be able to go to other parts of the hospital, or get a pass to leave the hospital for a short time.
- You may have jewelry, personal care items, belts, shoelaces or other personal belongings locked away during your stay. You may not be allowed to have items with glass or sharp edges, such as picture frames, CD cases or spiral notebooks.
- You may have to follow a schedule. There may be set times for meals, groups, treatments, medications, activities and bedtime.
- You may have physical or mental health tests. You may have blood tests to find out your medication levels or look for other physical problems that may be worsening your illness.
- You may share a room with someone else.
- Hospital staff may check on you or interview you periodically.
- Your prescribing doctor may not be able to see you right away. You will probably talk to several different doctors, nurses and staff members while you’re on the ward. You might have to ask for things you need more than once.
back to top
Your time in the hospital
You might want to ask a loved one to help you go through hospital check-in procedures and fill out forms. Ask your loved one to help you communicate with hospital staff if needed.
You or a loved one may also want to call the hospital in advance to find out about check-in procedures and items you can bring. Ask if you can bring music, soap, lotion, pillows, stuffed animals, books or other things that comfort you. Find out about visiting hours and telephone access. Be sure your family and friends are aware of hospital procedures. Tell them what they can do to help you.
If you sign yourself into the hospital, you can also sign yourself out, unless the staff believes you are a danger to yourself or others. If you are not a danger, the hospital must release you within two to seven days, depending on your state’s laws. If you have problems getting the hospital to release you, contact your state’s Protection and Advocacy agency.
You have the right to have your treatment explained to you. You have the right to be informed of the benefits and risks of your treatment and to refuse treatment you feel is unsafe. You also have the right to be informed about any tests or exams you are given and to refuse any procedures you feel are unnecessary, such as a gynecological exam or other invasive procedures. In addition, you have the right to refuse to be part of experimental treatments or training sessions that involve students or observers. Make sure the people treating you know your needs and preferences.
It may take time to get used to the routine in the hospital. If your symptoms are severe, some things may not make sense to you. Try to get what you can out of the activities. Concentrate on your own mental health. Listen to what others have to say in groups. Keep a journal of your own thoughts and feelings.
You will meet other people who are working to overcome their own problems. Treat them with courtesy and respect, regardless of what they may say or do. If someone is making you feel uncomfortable or unsafe, tell a staff member. Make the most of your time with your doctor. Make a list of questions you have. Ask your family or other hospital staff to help you with the list. Let your doctor and staff know about any other illnesses you have or medications you take. Be sure you receive your medications for other illnesses along with the medications for your depression or bipolar disorder.
back to top
Wellness after hospitalization
Know your treatment. Before you leave the hospital, make sure you have a written list of what medications to take, what dosage, and when to take them. Find out if there are any foods, medications (prescription, over-the-counter, or herbal) or activities you need to avoid while taking your medication, and write these things down. Track your medications and moods.
Learn all you can about your illness. Talk to your doctor about new treatments you might want to try. Find out what to expect from treatments and how you know if your treatment is working. If you think you could be doing better, ask another doctor for a second opinion.
Take one step at a time. You might not feel better immediately. Allow yourself to slowly, gradually get back to your routine. Give yourself credit for doing small things like getting out of bed, dressing or having a meal.
Prioritize the things you need to do and concentrate on one thing at a time. Write things down or ask friends and family to help you to keep from becoming overwhelmed.
Set limits. Take time to relax. If you feel stressed or exhausted, you can say no or cancel plans. Schedule time to care for yourself and relax, meditate, take a long bath, listen to music, or do something else that is just for you.
Have faith in yourself. Know that you can get well. If you were manic, you may not feel as productive as you felt before. But you will have a more stable and safe mood, which will help you be more productive over the long term.
Stick with your treatment. Go to your health care appointments, therapy and support groups. Be patient as you wait for medication to take effect. You may have some side effects at first. If they continue for more than two weeks, talk to your doctor about changing your medication, your dosage, or the time you take your medication. Never change or stop your medication without first talking with your doctor.
Recognize your symptoms and triggers. Feeling very discouraged, hopeless, or irritable can be symptoms of your illness. If you feel very angry, your mind starts to race, or you start to think about hurting yourself, stop, think, and call someone who can help. Keep a list of your triggers and warning signs, along with a list of people you can call for help.
Give relationships time to heal. Your family and friends may be unsure of how to act around you at first. There may also be hurt feelings or apologies that need to be made because of things you may have done while in mania or depression. Show that you want to get well by sticking with your treatment. Encourage your loved ones to get support from a DBSA support group if they need it.
Help your loved ones help you. Ask for what you need. Tell them specific things they can do to help you. If you need help such as housework, rides, or wake-up calls, ask.
Take it easy at work. Explain to your supervisor and co-workers that you have been ill and you need to take things slowly. You don’t have to talk about your depression or bipolar disorder. If someone asks questions, politely but firmly tell them you don’t want to talk about it. Do your best at work. Try not to take on too much. On breaks, call a friend or family member to check in.
Get support from people who have had similar experiences and are feeling better. Connect with a hospital aftercare group or DBSA group.
back to top
How can I find people who understand?
DBSA support groups are groups of people with mood disorders, their families and their friends who meet to share experience, discuss coping skills and offer hope to one another in a safe and confidential environment. People who go to DBSA groups say the groups:
- Provide a safe and welcoming place for mutual acceptance, understanding and self-discovery.
- Give them the opportunity to reach out to others and benefit from the experience of those who have been there.
- Give them new hope and belief that they can recover.
- Motivate them to follow their treatment plans.
- Help them understand that mood disorders do not define who they are.
- Help them rediscover their strength and humor.
People who had been attending DBSA groups for more than a year were less likely to have been hospitalized for their illness during that year, according to a DBSA survey.
back to top
How can I be prepared for a crisis in the future?
Make a crisis planning list. Briefly describe the kind of help you would like to receive if you have severe symptoms again. Include:
- Your doctor’s name and contact information
- Contact information of your support group and other trusted friends/family members
- Other health problems and medications you take
- Allergies and medications you cannot take
- Your insurance or Medicaid information and the hospital where you prefer to be treated
- Things that might trigger an episode, such as life events, travel, physical illness or work stress
- Warning signs such as talking very fast, paranoia, lack of sleep, slowed down movement, excessive alcohol or drug use
- Things people can say that will help calm or reassure you
- Things people should do for you such as take away your car keys and lock up anything you could use to hurt yourself
- Things emergency staff can do for you, such as explain things, talk slowly, give you space, or write things down for you
- Reasons your life is worthwhile and your recovery is important
How can an advance directive or a medical power of attorney help me?
An advance directive and a medical power of attorney are written documents in which you give another person authority to make treatment decisions for you if you are too ill to make your own. It is best to consult a qualified attorney to help you put together an advance directive or medical power of attorney. These documents work differently in different states.
back to top
The following organizations may provide additional help. DBSA assumes no responsibility for the content or accuracy of the material they provide.
National Association of Protection and Advocacy
(202) 408-9514 http://www.napas.org/
back to top
Treatment and Physical Tracking – Weekly Chart
Check the days you go to talk therapy and support group.
List your mood disorder medications, how many pills prescribed, and how many you take each day.
List your medications for other illnesses and any other supplements you take.
Check the days when you have side effects. If you have several bothersome side effects, use a line for each.
Check the days when you have a physical illness.
If applicable, check the days when you have your menstrual period.
If applicable, check the days when you use alcohol and/or drugs.
Write down how many hours of sleep you got.
Write down how many meals and snacks you had.
Check the days when you did some kind of physical activity or exercise.
Check the days when you spent some time relaxing.
Check the days when you reached out to other people.
Check the days when you had a major life event that affected your mood. List the events if there are more than one.
Fill in the box that describes your mood for the day. If your mood changes during the day, fill in the boxes for the highest and lowest moods and connect them.
If you experience a mixed state, check the box.
Look for patterns. See how your moods relate to your treatment and lifestyle.
Talk therapy / support groups
|Talk therapy||check the days you went to talk therapy|
|Support group||check the days you went to support groups|
|Medication name||Dose||# of pills per day||Total number of pills taken each day|
|check the days you had side effects|
|check the days you had side effects|
|check the days you had side effects|
|check the days you had a physical illness|
|check the days you had a physical illness|
|check the days you had a physical illness|
|Menstrual period||check the days affected|
|Drank/used drugs||check the days affected|
|Hours of night sleep||record the number of hours slept|
|Number of meals||record the number of meals eaten|
|Number of snacks||record the number of snacks eaten|
|Physical activity||check the days you did a physical activity|
|Relaxation time||check the days you spent time relaxing|
|Helped others||check the days you helped others|
|Major life event||Sun||Mon||Tues||Wed||Thu||Fri||Sat|
|check the day the event happened|
|check the day the event happened|
|check the day the event happened|
|Extremely manic||shade the box(es) that reflect your mood|
|Very manic||shade the box(es) that reflect your mood|
|Somewhat manic||shade the box(es) that reflect your mood|
|Mildly manic or hypomanic||shade the box(es) that reflect your mood|
|STABLE MOOD||shade the box(es) that reflect your mood|
|Mildly depressed||shade the box(es) that reflect your mood|
|Somewhat depressed||shade the box(es) that reflect your mood|
|Very depressed||shade the box(es) that reflect your mood|
|Extremely depressed||shade the box(es) that reflect your mood|
|Mixed state||check the box if you experience a mixed state that day|
back to top
The first time I was admitted to the psych ward, I was 16. I was still a minor, so I had the benefit of boarding with the youth in the juvenile behavioral unit in the local hospital. I wasn’t prepared in the least for what I would see and encounter, nor was my mind in a state to readily accept this place.
The tell-tale behaviors of mania and depression were present in me, leading up to the admission. But at first, my family and I didn’t know that these strange acts I exhibited were signs of bipolar disorder. While I waited for what seemed like hours in a hospital gown on a cold metal table in an ER admissions room by myself, Mom and Dad signed papers and consulted with the administration to see what could be done for my extraordinary outbursts and melancholy “suicidal” ideations—which, by the way, were not actually suicidal ideations or intentions. I simply had a sense of my life being cut short—a symptom of manic paranoia—which the hospital interpreted as a threat of harm to myself or others. This interpretation led to another tick against another piece of criteria for admission.
I had been seeing a psychiatrist who didn’t want to diagnose me at that age—for liability and precaution. She had met with us two or three times prior, but because I now needed around-the-clock monitoring, advised my parents to take me to the local hospital. Confused because I didn’t realize where they were taking me (my symptoms were that bad), I had no concept of what a psych ward was, let alone an extended stay in one. They said I may be there for a long weekend; it turned out to be three weeks.
My stay was rough because of the illness, but good for me. I don’t have regrets about the choices I made or my willingness to enter go there to begin with. It was the best place for me to be at that time, with the best help possible. Someone had to figure out what was wrong with me, as I clearly couldn’t. Bipolar disorder sort of snuck up on me at the height of my teenage-hood and hijacked my mind.
Article continues below
Concerned about Bipolar Disorder?
Take our 2-minute Bipolar quiz to see if you may benefit from further diagnosis and treatment.
Take Bipolar Quiz
I was finally diagnosed with biopolar disorder, after the three-week inpatient stay, during consultations with a doctor in the outpatient program. I think I knew all along that something was wrong when I was sick and not yet diagnosed; I just hadn’t been educated yet on mental illness. I was living it and realized—I’m bipolar. There is a reason my brain is malfunctioning. I had only heard the term “bipolar disorder” for the first time the previous year, but I knew it was manifesting in me after speaking to my psychiatrist at the hospital when my symptoms emerged.
Based on my experiences at 16 in the juvenile ward, and at 24 in the adult ward, I’ve gleaned some wisdom that may be helpful if you are readying yourself to enter a behavioral unit:
What I Wish I’d Known Before I Admitted Myself
- Bring your best advocate with you. It may be your spouse, parent, close friend or relative—someone who knows you and is familiar with your situation.
- Breath. Recognize that the staff wants to help you, not hurt you.
- Be patient. It’s a process—here are steps to go through and paperwork to be completed
- Once inside, advocate for yourself. The doctor will see you. Be honest with him.
- Your picture will be taken, and no, they are not stealing your soul.
- You will be in a secured unit, locked in. At times they let you out of the unit for visits or short excursions.
- You must earn your way out. Your behavior can hinder your release if you’re not cooperating with the staff and patients.
- Read your patient rights and understand them.
- Your personal belongings will be inventoried, so they will take out shoestrings, belts, hoodies, nail clippers, razors, and anything else deemed potentially dangerous.
- Don’t mind the eccentric behaviors of the other patients, they’re fighting a similar battle.
- Accept that the insides of the building may not be the most aesthetically pleasing. (That said, don’t concentrate on abstract paintings if they have them. Abstract art is a bad idea for psychotic symptoms).
- There will be a TV on at some point. The sound may seem to be calling your name. It’s not. Try to tolerate the audio-visual stimulation, but if you have to, leave the room.
- Be mindful of the opposite sex (or the same sex if you’re so inclined). Establish personal boundaries and adhere to them; the psych ward is not a place to start a romance.
- Listen to the staff and don’t give them a hard time.
- Be friendly and polite. There are humans here, not second-class savages.
- Seek out a friend and get to know some people.
- Give yourself time and space. You are on a journey to getting better and that takes time and space.
- Take a photograph in your mind’s eye. Journal about it. Capture the chaotic and colorful journey. Write about it. Express yourself. Get to know who you are at this time.
- Be kind, regardless. Don’t expect people to respect you because a.) everyone’s imperfect and b.) they can’t respect others if they don’t respect themselves.
- Challenge your mind and do a puzzle, but don’t read into it—it’s just a brain exercise.
- Take advantage of physical activity when there’s recreation time. Your body needs a physical outlet to help process the stress your mind is going through.
The admission and experience of staying in the psych ward was quite an adventure. I offer these pointers because knowing what I know now back then would have helped me get through the experience with less angst. While it was an unfamiliar and uncomfortable place to be, it was also the best place for me and worth it for my mental health.
Last Updated: Jun 4, 2019
Do I need to go to the hospital?
What other options do I have?
A hospital stay can be helpful in many situations, but it also has its drawbacks. It’s not the best long-term solution—you’re not likely to walk away from the hospital completely cured. But it can be a great first step. In the United States, a hospital stay can also be expensive. Fortunately, there are ways to get financial assistance, so you shouldn’t let this prevent you from keeping yourself safe if it’s your best option.
Whether you decide to go to the hospital or not, it’s important to know that you have lots of options. If you’re in crisis, you can call the National Suicide Prevention Lifeline at 1-800-273-TALK or text “MHA” to 741-741 to talk to a trained counselor from Crisis Text Line. For a longer-term solution, you can schedule an appointment with a therapist or talk to your doctor about trying a medication. Joining a support group can be helpful. You can also improve your mental health on your own by learning more about mental illness, opening up to someone you trust, and making lifestyle changes.
Who decides whether or not I’ll go to the hospital?
In most cases, you’ll need to make that decision for yourself. The laws vary by state, but usually you can only be hospitalized against your will if you present a “clear and present” danger to yourself or others. In other words, it has to seem like you’re really going to hurt someone if you aren’t hospitalized. If that is the case, you might be checked into the hospital by a friend or family member, or a mental health professional like a therapist or doctor. But more likely, if one of those people is worried about you, they will try to convince you to check yourself in voluntarily.
In some circumstances, you may want to consider creating a Psychiatric Advance Directive before going to the hospital. This is a written legal document that expresses your wishes about what types of treatments, services and other assistance you want or don’t want when you are having difficulty communicating or making decisions. You can also specify which facility you’d prefer to be taken to.
This post is presented in collaboration with Active Minds, the national organization dedicated to empowering students to speak openly about mental health.
Please note: This piece talks about a specific experience regarding suicidal thoughts and hospitalizations. Not all experiences will be or are the same.
October 10, 2017 – When someone is actively suicidal, we often tell them to call the National Suicide Prevention Lifeline, call 911, or go to the local Emergency Room. These are all correct responses, but they are also scary, big steps for someone in a mental health crisis to take. I am going to try to demystify what happens at the emergency room when you go there for suicidal thoughts and planning by sharing my own experiences.
After telling the ER staff the reason why I was there, I was evaluated.
Whenever you go into the ER, for whatever reason, you tell the staff why you are there. You can word this however you want: I am feeling suicidal, I have a suicide plan, I’m having suicidal thoughts, I’m feeling really depressed, etc. I went with my parents, so they talked to the staff for me because I was unable to. (If you feel as though you need support, it’s a good idea to go with your parents or guardians or someone you trust.)
In my visits to the ER, they have had a mental health crisis professional come to evaluate me. The evaluation is assessing your suicide risk to determine what level of care you need. This means that you should be extremely honest with the person- they are just trying to get you the help that you need and that fits your situation. I was asked if I have a plan, if I’ve had previous attempts/thoughts/hospitalizations, what medications I am on (if any), any issues going on in my life, and other questions to determine my mental state.
This is often the steps that the ER and evaluator will be following to determine your safety.
My level of care needed was determined and they found me a place in that level of care.
In mental health treatment, there are different levels of care, meaning how much supervision and treatment you need.
- Inpatient hospitalization (IP) is 24/7, acute care and support. You spend both days and nights there. Depending on your area, it may be a floor of a regular hospital or a freestanding psychiatric hospital. This treatment is also at behavioral health hospitals or clinics. Inpatient hospitalization is used when the person is at risk for harming themselves or someone else. The average length of stay is 5-7 days, but varies greatly. Since this is usually the outcome for an actively suicidal person, I will explain more about this treatment below.
- Partial hospitalization program (PHP) is an outpatient day treatment where you are there for 6+ hours either everyday or every week day. Outpatient means you sleep at home. This can be at the hospital, at a behavioral health clinic, or at a mental health care center. Partial hospitalization treatment usually consists of 1:1 therapy, psychiatry, group therapy, psycho-educational groups, and recreational/expression therapy.
- Intensive Outpatient Program (IOP) is about 3-4 hours, usually at night or in the afternoon, and is 3-4 times a week, Like partial treatment, you sleep at home. This option is used a lot in situations where the person is safe enough to be unsupervised but is struggling enough to need more intensive care than weekly therapy. This can also be done fairly easily in conjunction with school and/or work.
- Outpatient Treatment is your typical weekly therapy/psychiatry/group meetings. Sometimes if a person is safe but is experiencing suicidal thoughts and they don’t do Intensive Outpatient, they will do regular outpatient 2 or 3 times a week with their therapist or do weekly sessions with their therapist and supplement with a weekly group therapy session.
Inpatient hospitalization is there to keep you safe and stabilize you.
Each time I have been to the ER for suicidal thoughts, the evaluator decided inpatient was needed for me. Following this decision, they talked to my parents and I about the different hospitals in the area but explained that they might not all have beds. I was in the ER for several hours while they found a bed, I get blood taken, and they ran some tests. My inpatient program was not at the hospital the ER was in, it was in a freestanding behavioral health hospital, so I was transferred by ambulance. (Though one time they did let my parents take me since we had been waiting for over 6 hours and would have to wait longer for the ambulance.)
My room looked similar to this. The rooms are usually plain looking and empty, but not scary like old photos of “psychiatric wards” you see online! I had one roommate and decorated with quotes and pictures.
I’ll be honest, inpatient hospitalization is not a vacation. You lose a lot of freedoms in inpatient treatment. In my experience, they took away anything that I could possibly hurt myself (or others) with- shoelaces, strings in clothes, belts- anything sharp and anything long. But, I had to understand that it is for my safety. Being inpatient meant that I was a danger to myself and determined not safe unless under 24/7 care- I was monitored closely to make sure I was safe. During my time inpatient, I received 1:1 therapy, psychiatry, checks every 15 minutes or so, safety planning, recreational therapy, skills building, discharge planning, and expressive therapy.
Inpatient hospitalizations are not meant to make you better, they are meant to get you stable and get you out so that you can get the true treatment you need. Care doesn’t end after an inpatient hospitalization and you are not cured because of it- you are simply deemed safe enough to transfer to a lower level, less intense version of care.
Don’t be scared of getting the help you need
While inpatient hospitalization can be scary, it’s also life-saving. I have been in this type of treatment several times after going to the ER and being evaluated. Each time has been different, but each time I learned something valuable. I first experienced the healing powers of art therapy while inpatient. I played piano and basketball while inpatient. I made a good friend while inpatient. I had conversations that helped me see more clearly while inpatient. Leaving everything you know and love and having very scarce contact with the outside world sounds terrifying, but sometimes it’s exactly what we need at that time.
If you get evaluated and are placed in a lower level of care, try to not take that as “you’re not sick enough.” I know that those feelings can come up sometimes in those with mental illness. Inpatient treatment is not a gold star you get that proves you are ill. Your illness is valid, no matter the treatment. The evaluation is just to get you in the correct treatment you need at that moment. Try not to let it get to the point where you need inpatient- reach out and get help before you hit that crisis point.
When in a mental health crisis, it can be so hard to see clearly. Research hospitals around you beforehand and find out what they do for behavioral health cases. Some hospitals near you may be more equipped for mental health crisis situations better than others. Here are some questions you or someone you trust who is with you should ask during these times. If you are someone who lives with suicidal thoughts, knowing what to expect can help ease some of the burden of getting help. Don’t hesitate- you can do this!
Like what you’re reading? Go to our Sharing Your Story page, where you’ll find resources for sharing your own story, including story ideas, blog submission guidelines, tips for sharing your story safely and creative exercises to help you get started, and assignments for upcoming topics.
Write a blog post for AFSP! for our Submission Guidelines.
When Should You Consider Hospitalization for Depression?
I wish psychiatrists sent people with depression home with instructions on when to go to the hospital similar to the ones obstetricians give to pregnant women once they reach 37 weeks of gestation: when your contractions last for a minute each and are five minutes apart, start the ignition!
“How did you know it was time to go to the hospital?” a friend asked me the other day.
“I didn’t,” I replied. “My friends did.”
Each psych ward experience is different. And no doctor judges the decision to enter one in the same way.
In hindsight, I wonder why my therapist didn’t urge me to commit myself months before I did. I talked about wanting to die most of my hour with her. Because it was all I thought about. That idea, alone, gave me relief. But I guess since I had been depressed for so long and hadn’t attempted suicide before, she felt I wasn’t a threat to myself.
Eric didn’t recognize my dangerous state, either. He was used to seeing me with a Kleenex in my hand, because I cried during 80 percent of my waking hours. (That’s not an exaggeration.) I sobbed while I ate, cooked, peed, showered, ran, cleaned and fornicated. And that went on for a few 24-hour periods, like at least 100 of them.
Sometimes an outsider has the sharpest vision, like an out-of-town sister telling you how much your kids have grown since she saw them last.
It was two girlfriends who hadn’t seen me all summer who convinced me to pack my bags. When David’s preschool started back in September a year and a half ago, I joined my friend Christine for dinner after David’s (and her boys’) karate class. When she arrived home she called another friend, Joani.
“I’m worried sick about Therese,” she said. “She sat at the table like a zombie, not able to follow the conversation. She was crying at karate. The last person I saw that depressed is dead. We’ve got to do something.”
The next day Joani knocked on the door. I was in my robe because I was trying out the advice of some stupid magazine article: if you surprise your partner with sexy lingerie you won’t feel depressed. But instead of having amazing sex with Eric during his lunch hour (yeah right, I was crying the entire time), I listened to Joani tell me how concerned some of my friends were. I called my doctor to tell him I was going to the hospital.
It was absolutely the right thing to do. A person can’t fight suicidal urges forever. Eventually willpower wilts. And that day was getting closer for me. I couldn’t continue to expend 99.9 percent of my energy on NOT killing myself, on not pursuing one of five ways of ending my life, since everything in me gravitated toward the curtain of death.
My friends knew that Eric was planning on taking the kids to California to visit their newborn cousin Tia for four days. They knew I shouldn’t be left alone with my stash of prescriptions that could stop my pulse. Did they know that three-quarters of me had planned my suicide for then? Or did they see from my spaced-out gaze that I was too doped up on sedatives and antipsychotics to think clearly? Maybe both.
I’ve sat through enough psychiatric evaluations to know the right questions to pose to my friend Sarah.
“Do you have suicidal thoughts?” I asked her.
“All the time, or here and there?”
“They are getting more frequent.”
“Do you have a plan?”
“No. But I’m starting to think about some ideas.”
“Okay. You really need to see someone right away. I’m not qualified to say much more than that, but I suspect you need to give your body the chance to rest and recover so that you can get your strength back to fight this thing,” I told her.
That’s how one of the evaluating physicians at Johns Hopkins phrased it to me.
“You’re carrying this backpack full of heavy rocks. Lugging the thing around consumes all your energy, leaving you with only exhaust fumes with which to accomplish your other responsibilities, like taking care of your kids. A hospital stay will allow you to drop the backpack long enough to recover some of your strength. Because you are safe within our unit, you won’t have to devote so much stamina into not pursuing suicide. Does that make sense?”
Did it ever.
I gave my friend my therapist’s number.
“If you decide it’s time to go to the hospital, give me another call,” I said. “Since I’ve been to a few in the area, I can tell you which has the better menu. Deal?”
When Should You Consider Hospitalization for Depression?
Finding a HospitalDuring Check-InDuring the StayWhen Leaving the Hospital
It is important to carefully assess if hospitalization is necessary for yourself or a loved one and if it is the best option under the circumstances.
If you are contemplating hospitalization as an option for yourself, it can reduce the stress of daily responsibilities for a brief period of time, which allows you to concentrate on recovery from a mental health crisis. As your crisis lessens, and you are better able to care for yourself, you can begin planning for your discharge. In-patient care is not designed to keep you confined indefinitely; the goal is to maximize independent living by using the appropriate level of care for your specific illness. If you are able, you may want to consider creating a Psychiatric Advance Directive before going to the hospital. A Psychiatric Advance Directive is a written legal document that expresses your wishes about what types of treatments, services and other assistance you want or don’t want during times when you are having difficulty communicating or making decisions. It provides a clear statement of your medical treatment preferences and other wishes and instructs providers of care. You can also use it to grant legal decision-making authority to another person, also called an “agent”, to be your advocate at times when you cannot make decisions for yourself. For more information on psychiatric advance directives and how to prepare one, click here.
There are also times when a person becomes so ill that they are at risk of hurting themselves or others and hospitalization becomes necessary even though the individual does not wish to enter a hospital. While seeking help voluntarily is always preferable, a family member may have to make the decision to hospitalize someone with a mental illness involuntarily. This act, while difficult, can be more caring than it seems if that is the only way to get someone the care they need, especially if there is a risk of suicide or harm to others. A family member should consider working with their relative who is at risk of a mental health crisis if they would like to create a Psychiatric Advance Directive during a time when they are well.
Finding a Hospital
Your treatment options depend on the level of care you will need to receive. Who administers that care depends on where you go to seek treatment. Listed below are several different types of facilities that offer different levels of care:
- In-patient, 24-hour care is provided by the psychiatric units within general hospitals, and also at private psychiatric hospitals. Care is supervised by psychiatrists, and provided by psychiatric nurses and group therapists.
- Each state has public psychiatric hospitals that provide acute (short-term) and long-term care to people without means to pay, those requiring long-term care, and forensic patients.
- Partial hospitalization provides therapeutic services during the day, but not on a 24-hour basis. It can be an intermediate step between in-patient care and discharge.
- Residential care is 24-hour psychiatric care provided in a residential setting for children or adolescents, or residential programs for the treatment of addictions.
It can be helpful to talk with your psychiatrist or therapist, your local Mental Health America affiliate, or members of area support groups for recommendations when choosing an in-patient or residential treatment facility. In addition, you can consult the resources listed below to assist you in your search.
- American Association of Children’s Residential Treatment Centers
- American Residential Treatment Association
- Boston University School of Public Health’s AlcoholScreening.Org (listing of Alcohol and Substance Abuse treatment facilities)
- Behavioral Tech, LLC
- Borderline Personality Disorder Resource Center
- Depression and Bipolar Support Alliance (click “Enter DBSA Find A Pro” to view list of recommended hospitals or treatment facilities)
- International Obsessive Compulsive Disorder Foundation’s listing of Intensive Treatment programs
- SAMHSA’s National Mental Health Information Center-Mental Health Facilities Locator
- SAMHSA’s Substance Abuse Treatment Facility Locator
If your hospitalization is voluntary, or if your psychiatrist prescribes hospitalization, take the time to learn more about the recommended facility in which you will be receiving treatment. Call the facility in advance to learn about admission procedures, daily schedules, what items you can and cannot bring, and any other day-to-day policies you want to know about. You should also inquire about check-out procedures. Different rules apply depending on how you were admitted.
After you read each section below, review the lists of common questions that come up at different points of hospitalization. Feel free to ask some of these questions ahead of time in an effort to help you feel more acquainted with the treatment facility and its procedures. The more comfortable you feel, the easier it may be to comply with your psychiatrist’s recommendations for treatment.
Before or During Check-in
Below are some questions you can ask regarding check-in at the treatment facility:
- Does your facility treat patients with my specific diagnosis only?
- If I have other health or emotional problems will I receive treatment for these problems also?
- Does your facility require tests when admitted? If so, what are they?
- When will the initial evaluation take place?
- Who will evaluate me when I am admitted?
- What are the person’s qualifications? Title?
- Will this person continue to treat me?
- Will I be seen by this professional on a regular basis?
During the Stay
Before your treatment can begin, you will undergo a complete physical examination to determine the overall state of your health. The information collected during this examination, and the information collected during the initial evaluation will be considered when building your treatment plan.
You have the right to have your treatment explained to you in order to be informed of the benefits and risks, and you have the right to refuse treatment if you feel uncomfortable or if you feel it is unsafe. You also have the right to have your health information protected and kept private through confidentiality. The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule gives you rights over your health information and sets rules on who can look at and receive your health information. For more information on HIPAA, visit http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Below are some questions you can ask regarding your stay at the treatment facility:
- When can family members visit? For how long?
- Will I be allowed to make and receive phone calls?
- What clothes should I bring?
- Can I walk around the hospital? Are there restrictions on where I can and cannot go?
- Will I be able to leave the treatment facility grounds?
- How long will I be at the facility? Who makes this decision?
- Will I have to share a room with someone else? Can I request a single room?
- Will I have a daily schedule or set times for activities, treatments, and medication?
- What types of activities will I be involved in?
- Is there a set bedtime or curfew? When will this be?
- When can I (or another family member) talk to the therapist or doctor?
- Will we be able to discuss treatment with the doctor or therapist? When? How often?
- Will I (or my family) be advised of changes in my treatment?
- Is therapy in a group setting or one-on-one? Is it part of my treatment plan?
- Will I have to undergo tests while I am treated? Can I refuse these tests?
- Will I be able to continue schoolwork while receiving in-patient care?
- If classes are offered to patients, what are they and who teaches them?
When Leaving the Hospital
If you were admitted voluntarily, you may have the option of checking out against medical advice; which, in other words means, if you feel you are ready to leave the hospital on your own without a “green light” from your doctor, you maybe be allowed to go. However, if your hospitalization was court ordered, or if a family member admitted you involuntarily, you will need to complete an evaluation process to determine if you are in a condition to care for yourself outside of 24-hour inpatient care. Every facility has different policies and procedures, so check with the facility in which you are seeking or receiving care.
Below are some questions you can ask regarding your discharge:
- Who will make the evaluation for my discharge? When will this happen?
- What can my family and I expect when I am discharged?
- Will someone advise me and my family about adjustment concerns such as the need for further counseling or a medication schedule?
- Will I be on medications? Which ones? What is the dosage?
- How will these medications help? Are they habit-forming? What are the side effects?
- How long will I have to take this medication?
- If I leave the hospital without permission how will the hospital handle this? If this occurs, what is my family’s responsibility?
- How soon after I have been discharged can I continue with my schoolwork?
- What follow-up treatment or support group options should I consider?
For more information on ways to maintain wellness after discharge from the hospital, please visit the section titled “Wellness after Hospitalization” on the DBSA web site on Understanding Hospitalization for Mental Health.
What Are Your Rights Regarding Hospitalization for Depression?
Many people with depression may need hospitalization because they feel suicidal or unable to take care of themselves day-to-day. A doctor must evaluate whether hospitalization is necessary and appropriate and whether a less intense treatment setting, such as an intensive outpatient program or partial hospital program, may be a more appropriate alternative. Sometimes patients are hospitalized against their will if they pose an immediate danger to themselves or others. The laws concerning hospitalization for depression vary from state to state. Generally, you can only be hospitalized against your wishes if you are considered to be a risk to yourself or others or are gravely impaired and unable to take care of yourself.
During an emergency, a health care professional or police officer may require you to be evaluated at a hospital. Once there, a hospital doctor will talk to you and decide whether you actually need to be hospitalized. While the doctor has the final say whether you get admitted, friends or family members can be involved by providing input about your symptoms and functioning to the health care professionals who are evaluating you. If a doctor believes that involuntary hospitalization is necessary, the hospital has the right to evaluate your condition, usually for several days, before asking a judge whether ongoing involuntary hospitalization and medications or other treatments are medically warranted and can therefore be administered against your will.
The length of your stay is determined by the staff based on your clinical condition, although insurance companies can independently decide if they no longer believe continued hospitalization is “medically necessary.” In this situation, they may refuse to pay for ongoing treatment in the hospital. If your doctor disagrees with an insurance company’s decision to refuse to pay for ongoing treatment, the doctors typically will appeal their decision. If the doctors no longer think that you are in danger, you will be released within two to seven days, depending on the laws in your state. If you disagree with the hospital’s assessment, you can ask to speak with a mental hygiene lawyer in order to request that a judge rule on the need for ongoing involuntary hospitalization. Talk to your state’s Protection and Advocacy agency.