Reasons for Psychiatric Hospitalization

A psychiatric hospital stay often begins with an emergency room visit, though sometimes can be arranged in advance.

There are different reasons for a hospital stay:
-a high or immediate risk of suicide
-inability to safely care for self at home
-diagnostic uncertainty with serious symptoms requiring a more urgent, comprehensive medical evaluation (e.g. delirium)
-behaving dangerously due to psychiatric symptoms (e.g. a manic state)
-initiating a treatment that is difficult as an outpatient (e.g. ECT, major medication changes)
-respite for self and for other caregivers
-a comprehensive inpatient reassessment of complex or chronic problems (e.g. refractory depression or psychosis)

Many psychiatric hospital stays nowadays are brief--perhaps a few days-- with an aim to be just long enough to help someone through an immediate crisis, while quickly ensuring that there is some kind of follow-up outside the hospital.

Other stays average 2 weeks, allowing for a more thorough evaluation and change in treatments.

Sometimes there are longer stay hospitalizations, which can last for months. Manic states often require longer stays of this type.

There are chronic psychiatric hospitals for those who have severe, active, long-lasting illness and who cannot manage outside the hospital. In general, chronic psychiatric hospitalization is becoming much more uncommon, partly due to a philosophy of trying to optimize outpatient help and community resources, but partly due to budget cutting. It may be that some persons who may benefit from chronic inpatient care, and who are not doing well with other community resources, may be at risk of "falling through the cracks" in the system, and may end up struggling with a very poor quality of life, often in a homeless state.

The Emergency Room

Hospital emergency rooms are always open; emergency help is always available. If you can't make it through the day, or through the hour, and your other resources are not sufficient, you can always be seen and taken care of in the hospital.

There are several points of entry to the hospital system. Sometimes an admission to a psychiatric ward can be arranged in advance, but quite often the entry point is the hospital emergency room.

Emergency rooms are chaotic places. There are a variety of frustrations that one might have to deal with. There may be a long wait to be seen by a physician. There might be a lot of noise, and a lot of upset due to various other emergencies being dealt with. The seats or beds may be physically uncomfortable. You would probably be seen by a variety of different people, and it may be very frustrating and exhausting to have to tell your story several times: first to a triage nurse, then to an emergency physician. If psychiatry is consulted, then there might be a student or resident who would see you next, prior to the actual psychiatrist. Along the way, each interviewer may be different in their level of comfort, thoroughness, or rapport with psychiatric interviewing. You may encounter an interviewer who is tired or impatient.

If you are in a time of urgent emotional distress, these frustrations can be especially hard to deal with. I encourage you to bear with it. At the very least, the emergency room is safe, and it can be the beginning of a powerful, sometimes life-saving therapeutic experience.

Here are two suggestions that can make an emergency room visit a little easier:
1) bring a friend or loved one with you, if possible
2) if you have a doctor, therapist, or psychiatrist, ask him or her to call or fax the emergency room, to better inform them about you in advance. This can often make a big difference, and help the process proceed more smoothly.