What Is Psychiatry?
Psychiatry is a sub-specialty of medicine that is devoted to both the study and treatment of mental illnesses. Mental illnesses are medical conditions that disrupt a person’s thinking, feelings, mood, ability to relate to others and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life. Mental illnesses are serious medical illnesses. They cannot be overcome through “will power” and are not related to a person’s “character” or intelligence.
Read more about mental illnesses.
Psychiatric assessment for a person with a mental illness may be performed by a psychologist or psychiatrist. This assessment usually begins with a check of current mental status and collection of a complete case history about the mental illness and other stressors in the personal life. This information is used to diagnose mental illnesses.
Mental illnesses are diagnosed using the criteria in such diagnostic manuals as The Diagnostic and Statistical Manual of Mental Disorders (DSM-V), put out by the American Psychiatric Association as well as the International Classification of Diseases (ICD) put out by the World Health Organization (WHO).
How Are Mental Illnesses Treated?
Treatment for psychiatric disorders uses a variety of methods including, psychotherapy, medications, psychoactive meditation, as well as other techniques. Treatment for mental illnesses may be given on an inpatient or outpatient basis, depending upon the severity of symptoms, aspects of the mental illnesses, and other factors.
Innovations in the range of evidence based medications, therapy services such as psychiatric rehabilitation, housing, employment and peer supports have made wellness and recovery a reality for people living with mental health conditions.
Choosing the right mix of treatments and supports that work for you is an important step in the recovery process. Treatment choices for mental health conditions will vary from person to person. Even people with the same diagnosis will have different experiences, needs, goals and objectives for treatment. There is no “one size fits all” treatment.
When people are directly involved in designing their own treatment plan, including defining recovery and wellness goals, choosing services that support them and evaluating treatment decisions and progress, the experience of care and outcomes are improved.
There are many tools that can improve the experience on the road to wellness: medication, counseling (therapy), social support and education. Therapy can take many forms, from learning relaxation skills to intensively reworking your thinking patterns. Social support, acceptance and encouragement from friends, family and others can also make a difference. Education about how to manage a mental health condition along with other medical conditions can provide the skills and supports to enrich the unique journey toward overall recovery and wellness.
Together with a treatment team you can develop a well-rounded and integrated recovery plan that may include counseling, medications, support groups, education programs and other strategies that work for you.
When Does Inpatient Hospitalization Occur?
If you have severe symptoms of an illness like depression or bipolar disorder, a brief stay in the hospital can help you stabilize.
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.
If a person is very ill and refuses to go to the hospital or accept treatment, involuntary hospitalization is an option. The legal standard for an involuntary hospitalization requires that a person be considered a “danger to self or others.” This type of hospitalization usually results in a short stay of up to 3 days but can occasionally last a week or so longer. For an involuntary hospitalization to be extended, a court hearing needs to be convened, and a judge and two doctors must agree that there is still a need for hospitalization. The rules for involuntary hospitalization are done at the state level. The initial criteria are typically based on whether or not there is an immediate safety risk to his or herself or others. In other states, other criteria, such as being severely disabled, may be used as criteria for involuntary hospitalization.
What Is Inpatient Psychiatric Treatment?
There may be times when a person is admitted to the hospital for intensive treatment. Private psychiatric hospitals, general hospitals with a psychiatric floor or state psychiatric hospitals are designed to be safe settings for intensive mental health treatment. This can involve observation, diagnosis, changing or adjusting medications, ECT treatments, stabilization, correcting a harmful living situation.
If a person and their doctor agree that inpatient treatment is a good idea, they will be admitted on a voluntary basis, meaning that they choose to go. Some private hospitals will only take voluntary patients.
Before a person is discharged from the hospital, it is important to develop a discharge plan with a social worker or case manager. Family members should be involved in discharge planning if the person is returning home or if they will need significant support. A good discharge plan ensures continuous, coordinated treatment and a smooth return to the community.
Treatment for mental illnesses have changed dramatically over the past few decades. While in the past, those with mental illnesses were confined to a psychiatric hospital for periods greater than six months (sometimes for several years), most people today are treated for their mental illnesses on an outpatient basis.
Once in the care of a hospital psychiatric unit, people with mental illnesses are continually assessed by a group of doctors and nurses who specialize in the treatment of mental illnesses. Medication and treatment plans are developed with a team of doctors, psychologists, psychiatric social workers, therapists, occupational therapists, psychiatric nurses, and pharmacists. Those who are admitted to an inpatient psychiatric hospital may be admitted voluntarily or involuntarily.
What Are The Goals of Inpatient Psychiatric Care?
While the first goal of inpatient psychiatric care is to stabilize the person so that he or she is no longer a danger to his or herself or others, there are a number of other goals that can be met through inpatient psychiatric care.
- Titration and experimentation with medications to treat the mental illness.
- Group therapy to connect with other people experiencing similar mental illnesses.
- Supportive structure aimed at establishing normal, stabilizing routines for the day and night.
- Individualized goals for each person.
- Development of proper self-care habits – from resting to hygiene, to medication compliance.
- Learning to take responsibility for one’s actions.
- Boosts self-esteem by being part of a community.
- Forming relationships and supporting people going through the same things.
- One-on-one therapy to work through problems, past and present.
- Additional types of therapies, like occupational, art, animal, and music therapy.
What Is Involuntary Admission To A Psychiatric Unit?
Involuntary Commitment (or Civil Commitment) is a legal process in which a person who has severe mental illness is ordered by the court into treatment at an inpatient psychiatric 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.
If a person is very ill and refuses to go to the hospital or accept treatment, involuntary hospitalization is an option. The legal standard for an involuntary hospitalization requires that a person be considered a “danger to self or others.” This type of hospitalization usually results in a short stay of up to 3 days but can occasionally last a week or so longer.
For an involuntary hospitalization to be extended, a court hearing needs to be convened, and a judge and two doctors must agree that there is still a need for hospitalization. The rules for involuntary hospitalization are done at the state level. The initial criteria are typically based on whether or not there is an immediate safety risk to his or herself or others. In other states, other criteria, such as being severely disabled, may be used as criteria for involuntary hospitalization.
The criteria for an involuntary psychiatric commitment are established by law and vary tremendously from nation to nation and (in the US) state-to-state.
Commitment proceedings usually follow a period of emergency psychiatric hospitalization during which the mentally ill individual with acute psychiatric conditions is held for 72 hours (also known as the 72-hour hold). During those 72 hours, an individual is:
- Evaluated by a team of mental health professionals
At the civil commitment hearing, it’s determined whether or not the person should continue to be involuntarily held for further treatment.
Why Are People Involuntarily Committed To Psychiatric Hospitals?
The laws vary widely from state to state, but the person must be suffering from a mental illness to be committed. Other factors that states may consider are dangerous behavior toward self or others, grave disability and the need for treatment. While most states require that the person presents a clear and present danger to himself or others in order to be committed, this is not true for all states. In some, involuntary hospitalization may occur if individuals are refusing needed treatment even though they are not considered to be dangerous.
Less common criteria used by some states include responsiveness to treatment and the availability of appropriate treatment at the facility to which the person will be committed; refusal of voluntary hospital admission; lack of capacity to consent; future danger to property; and involuntary hospitalization as the less restrictive alternative.
Most areas of the world confine those who are mentally ill to such an extent that it impairs abilities to reason, or “found incompetent.”
It is important to note that involuntary commitment to a psychiatric hospital for a personality disorder, social deviance, or substance abuse is not allowed.
The most common reason for involuntary commitment to a psychiatric hospital is because the person is considered to have a mental illness, severe dementia or other intellectual disability that means the person is a:
- A danger to him or herself – such as in the case of people who have attempted suicide or confessed to plans of a suicide.
- A danger to others – such as people who are in psychosis, driven by delusions or hallucinations to harm themselves or other people.
Who Can Get Someone Involuntarily Committed To An Inpatient Psychiatric Facility?
Emergency detentions, in which immediate psychiatric help is being sought, are usually initiated by family members or friends who have observed the person’s behavior. Sometimes it’s initiated by the police, although any adult could request an emergency detention. The exact procedures vary by state, with many states requiring judicial approval or evaluation by a doctor confirming that the person meets the state’s criteria for hospitalization.
People may also be admitted for what is known as observational institutionalization, in which hospital staff may observe the patient to determine a diagnosis and administer limited treatment. Application for this type of hospitalization can usually be made by any adult having a reason to do so, but some states require that the application is made by a doctor or hospital personnel. And most require that an observational institutionalization receives the approval of the courts.
The third type of hospitalization, extended commitment, is a bit more difficult to obtain. Generally, it requires one or more persons from a specific group of people – such as friends, relatives, guardians, public officials and hospital personnel – to apply for one. Often a certificate or affidavit from one or more physicians or mental health professionals describing the patient’s diagnosis and treatment must accompany the application. In virtually all states a hearing must be held, with a judge or jury making the final decision about whether the person can be held.
How Long Does Involuntary Hospitalization Last?
Emergency detention is typically only for a short period, with the average being about three to five days. It can vary a bit by state, however, ranging from 24 hours in a few states to 20 days in New Jersey. In the states that allow for observational commitment, the length of hospitalization can vary considerably, ranging from 48 hours in Alaska to six months in West Virginia.
A typical length for extended commitment is up to six months. At the end of the initial period, an application can be made for the time to be extended, generally for one to two times longer than the original commitment. Requests can be made for further commitment when each period expires, as long as the patient continues to meet the legal criteria.
Can a Patient Be Forced to Receive Treatment?
People cannot be forced to receive treatment unless there has been a hearing declaring them legally incompetent to make their own decisions. Even though the person has been hospitalized involuntarily, most states will treat the patient as being capable of making his own medical decisions unless it has been determined otherwise.
People in immediate danger may be given medications on an emergency basis. However, these medications are directed at calming the patient and stabilizing his medical condition rather than treating his mental illness. For example, a sedative might be administered to prevent the person from harming himself, but he could not be forced to take an antidepressant, as this is considered to be treatment.
What Is Voluntary Commitment to Inpatient Psychiatric Care?
The large majority of people (88%) who receive inpatient psychiatric care do so voluntarily – or, who decide freely to enter the inpatient psychiatric hospital for treatment. It’s important to note that voluntary psychiatric patients aren’t entirely free to leave the unit without the permission of the staff. Should a person who has been voluntarily committed prove to be a danger to him or herself or others, he or she may be detained via involuntary commitment for up to 24 hours.
Voluntary admission to a psychiatric facility happens very similarly to the way that one is admitted to a hospital. Your GP or psychiatrist may write you a referral and you may check-in for treatment at an agreed-upon time.
You must carefully assess if hospitalization is necessary and if it is the best option under the circumstances.
If you are contemplating hospitalization 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. Inpatient 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.
What Sorts Of Freedom Are Available At Inpatient Psychiatric Hospitals?
One of the major benefits to staying as an inpatient at a psychiatric hospital is the reduction of every day stresses. This comes at a cost of personal freedom.
Most inpatient facilities limit the amounts and types of belongings brought inside. Activities are scheduled. Usage of television and internet may only occur at certain times of the day. Most facilities have a strict bedtime as well.
Finding An Inpatient Psychiatric Hospital:
Once you have decided to undergo inpatient psychiatric treatment, you’ll have to choose a hospital. This will, in part, depend on the level of care you need to receive. Who administers that care depends on where you go to seek treatment.
- 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.
What Happens After Checking Into The Psychiatric Hospital?
Generally speaking, after arriving at the psychiatric hospital, a nurse will meet with you to discuss your mental illness and problems.
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.
Ask these questions upon check-in at the 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?
You will be searched to make sure that you’re not carrying anything dangerous on you and your belongings will also be inspected. Anything considered contraband (something as innocuous as mouthwash may not be allowed) will be removed and given back to you when you leave.
Your first hours will likely be spent settling into the hospital as your treatment team learns more about you so a treatment plan can be developed. Within 24 hours of admittance, you will speak to a doctor for a complete psychiatric evaluation.
Goals for treatment at a psychiatric hospital center around discharge planning, developing healthy coping mechanisms, working through mental illnesses, obtaining proper medications, as well as learning basic self-care.
During Your 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 making 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 during your stay:
- 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?
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.
Self-Care and Wellness after Hospitalization
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?
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. 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 a symptom 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.
How Long Will I Stay At An Inpatient Psychiatric Hospital?
The average length of stay for an adult in a psychiatric facility is 12 days. Discharge planning is begun on the first day of admission to the unit. Medical research and new, highly effective treatments mean that those who suffer from mental illness can recover more quickly than people have in the past.
Children In Inpatient Psychiatric Facilities:
Both teens and children can suffer from mental illness. Certain mental illnesses often emerge during the early years. When a child’s mental illness symptoms become very severe, it may be suggested to hospitalize the child. The following things will be taken into consideration:
- Is the child an actual danger to him or herself or others?
- Is the child’s behavior bizarre and destructive?
- Does the child need medication that must be carefully monitored?
- Does the child need 24 hour care to stabilize?
- Has the child failed to improve in less restrictive environment?
While a child is hospitalized in a psychiatric facility, a treatment plan – including goals for discharge – will be created. The child may have group therapy, individual therapy, family therapy, and occupational therapy. Treatment will also focus upon academics. To increase social skills, children are often involved in activity therapy.
The family of the child is a major part of recovery from childhood mental illness, so the child’s treatment team works closely with parents and siblings to ensure proper communication, teach the family about the mental illness, recovery prognosis and treatment options.
Families will learn how to work with their mentally ill family member and cope with the stresses that accompany those mental illnesses.