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)
- 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.
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.