What to Expect If You Need Inpatient Hospitalization
When depression requires critical care
Posted Nov 01, 2019
Not every individual who struggles with depression will experience suicidal urges or severe symptoms that require a higher level of care. But if you do, inpatient psychiatric hospitalization can be a meaningful treatment.
Yes, you read that correctly.
Inpatient hospitalization for psychiatric illness has come a long way from straight-jackets, rubber rooms, and metal beds. A long way from wicked nurses or frightening procedures.
Inpatient hospitalization can be voluntary—meaning you agree with your treating therapist, doctors, or loved ones to seek more intensive care. Other times, inpatient hospitalization is not voluntary. This is clinically called involuntary or compulsory hospitalization, where you do not wish to go or seek hospital care.
Outcome studies show that voluntary hospitalization results in more positive outcomes than involuntary hospitalization. In this article, voluntary inpatient care will be the subject focus.
Inpatient Treatment Settings
Inpatient psychiatric services are often a designated wing within a hospital. The inpatient unit looks more like a college dorm than a hospital floor. The unit generally has single or double rooms for patients and group/individual therapy rooms, as well as common areas for eating and relaxing—and offices for staff and clinicians. It is a secured environment, arranged to keep patients safe and manage the floor with continuity.
When you are in a severe crisis with depression, your therapist may call ahead to the hospital to help with admission. He or she may inquire if a bed is available and give a cursory overview to the admitting caseworker. This helps the transition to inpatient treatment move as quickly as possible for you.
Your therapist will tell you that a team of professionals on the inpatient floor will likely include psychiatrists, psychologists, social workers, nurses, nutritionists, recreational therapists, music and art therapists—and if you're a child or teenager, school teachers and pediatricians too. It's helpful to know that adult inpatient floors work only with adult individuals. And pediatric inpatient floors work only with children and adolescents.
Once there, you'll be evaluated for admission to the unit by a crisis team and assigned a clinical caseworker. You may get your blood drawn or be asked for a urine sample to rule out any medical conditions that could be causing your severe depressive symptoms (adverse drug reactions, diabetes, severe anemia, or hypothyroidism, to name a few). For safety purposes, there'll be rules regarding acceptable clothing, accessories, and food.
If your inpatient stay is planned, you can pack a bag of comfortable clothing ahead of time, but avoid belts, strings, shoelaces, and other potentially self-harming accessories. Another good thing is to make a list of all the medications you take, as well as all the professionals who work with you.
Once admitted, you'll find the treatment center follows a daily and evening schedule. Meals, classes, individual, group, or family treatments, and periods for rest or recreation will have set times. Usually, anyone can come and visit you, but you might be limited as to how many can see you at a time.
Another thing to know is that visiting hours occur every day in most units—sometimes twice a day. Payphones are also available if you don't have access to your own devices. Weekends have less structure and treatments and make allowances for home passes when treatment goals are reached.
While receiving inpatient psychiatric treatment, it’s important to note that you may see others who have struggles that are similar to, less intense than, or more intense than your own. Though it may be distressing, over time, it can show you how others manage their chronic or acute mental illnesses.
The average hospital stay for an adult is about 10 days—though your symptoms and recovery time may result in less or more time. For children and teenagers, stays are typically about eight days, but that, too, can be shorter or longer. Treatment will be unique to your needs, so don't use your time spent inpatient as a measurement of success or failure. Medication titration, symptom reduction, confidence, and mastery of learned skills are not the same for everyone.
The goal of the inpatient program is to decrease the intensity of depression, reduce the risk for suicide, improve coping skills, adjust medication, or incorporate other treatments. These are part of your treatment plan, which you and your team will openly discuss and revise. When reduction of depressive symptoms and measurable goals are reached, you'll be discharged—with a return to treatment with your outside therapist(s), with whom the team has been in contact during your stay.
Sometimes, though, if your symptoms have improved significantly, but your treatment team thinks you need additional continued support, a partial hospital program or day hospitalization might be recommended. In this kind of treatment, you will be discharged home, but with a prescribed daily visit to the hospital for outpatient services. Generally, these services are available during the day—and even late in the afternoon or early evening, so you can work or go to school uninterrupted.
How to Reduce Shame and Stigma
Inpatient hospitalization may upset or frighten you—or make you worry that you'll be judged or criticized because you can't cope with your depression.
These feelings are not uncommon.
To help reduce shame or stigma, remember, severe depression isn't a result of weakness or laziness. Or poor parenting, if your child needs inpatient care. Suicidal thinking doesn’t happen because you're selfish. Or aren't smart enough to know how to fix things in life. Depression is a serious illness that can sometimes require immediate, intensive, and consistent care.
Accepting hospitalization takes grit and courage, and don’t ever let anyone tell you otherwise. It will feel scary at first, but it will likely lead to significant change and meaningful experiences.