How Inpatient Mental Health Treatment Works
Have you ever wanted to learn about inpatient mental health treatment but were afraid to ask? Maybe you’re wondered about it for yourself or a friend. Maybe you’ve been curious about how it connects to therapy in the mental healthcare continuum. Or maybe you just want to know what to do in case of a mental health emergency. Regardless of why you wondered, we’re here to help!
Inpatient mental health treatment is an essential, life-saving level of care that more people should know about and use but is still widely feared, stigmatized, and misunderstood. We think it's time to erase the stigma.
Going to a hospital for mental health treatment is simply what you do to get the right level of care when you're in crisis. It's not that different from going to the hospital for a medical emergency.
It’s only fair to acknowledge that no matter what kind of hospital it is, no one really wants to go to a hospital. It’s also true that psychiatric hospitals in particular come with some very real downsides. All that said, inpatient mental health treatment is not the Gothic horror it’s often shown to be in movies or television.
Not everyone who needs or wants therapy will ever need inpatient treatment, but some will—and that’s okay. It’s a service that’s there for exactly when you need it and for only as long as you need to be there. The goal of inpatient treatment is to get you stable enough to continue your treatment in the community.
Inpatient treatment is nothing more and nothing less than this: a short stop to get the help you need to get through a crisis. But that simple fact means it could be what saves your life.
You may never need inpatient mental health care. But will you know what to do or what to expect if you do need it—or if a loved one does? We want to shine a light on this vital service and bust the myths that keep people from getting it when it is what they need.
Who Is Inpatient Mental Health Treatment For?
Anyone can experience a severe mental health episode, regardless of their history or current circumstances.
Like medical care, mental health care is a continuum designed to move you through it, not a sorting system that assigns care based on what kind of person you are.
And inpatient care is simply what you need when your mental health symptoms become too severe to safely manage on your own.
When Do You Need Inpatient Treatment?
Common reasons for getting inpatient mental health treatment include:
- Manic episodes
- Severe depression
- Self-harming behavior
- Suicidal intent or a plan
- Altered mental status or delirium
- Psychosis (delusions and hallucinations)
- Escalating reckless or impulsive behavior
It’s important to understand that what determines if you need hospitalization is your symptoms, not your diagnosis or condition. Transient severe mental health episodes can have causes other than a chronic mental health condition, such as:
- Reactions to prescribed medications,
- Complications of medical conditions,
- Severe emotional stress or trauma,
- Extreme physical stress,
- Head trauma, or
- Substance use.
That said, the primary causes for psychiatric hospitalization are mental health conditions, and some conditions are more likely to require inpatient treatment than others. These are:
- Mood disorders (which include major depressive disorder and bipolar disorder),
- Psychotic disorders (which include schizophrenia and schizoaffective disorder), and
- Substance-use-related disorders (including substance-induced psychosis or depression).
The reason these conditions are more likely to send you to the hospital is because their symptoms are the ones that put you at the greatest risk of harm. Psychosis, bipolar mania, and severe depression all make it very hard to care for yourself or keep yourself safe.
While it’s possible for transient psychosis (which can include delusions, hallucinations, or disordered thinking) to be triggered by anything that changes your mental status (see the list above), it’s more common to experience a psychotic episode in the course of a chronic psychotic disorder like schizophrenia.
If you have a psychotic disorder, your road to recovery often begins with your first hospital admission and continued follow-up care in the community.
Mood disorders sometimes cause psychotic episodes, but they’re more likely to put you in the hospital because of a severe depressive episode.
Depressive episodes can come on suddenly or build slowly over time. What makes depression insidious is how quietly it can become severe. All too often, people suffer in silence with worsening depression until it reaches a crisis point.
What starts as mild depression can expand over time, slowly sucking away your capacity to feel joy or hope. You might withdraw from life further and further until you’re barely making it. And while you might learn how to function this way, you can sometimes get to a point where you just can’t anymore. And that might be the point when you need inpatient care.
How Hard Is It to Get Inpatient Care?
Sadly, inpatient mental health care can be hard to get, especially if you’re seeking it voluntarily. Since there aren’t enough inpatient beds to meet the need, inpatient facilities often have to limit care to the people with the most severe symptoms.
And because many psychiatric hospitals have these restrictive admissions policies, people who qualify for voluntary admission often also meet the standard to be committed involuntarily.
What Is Involuntary Commitment?
We’ve written about this before, but in short, being committed is what happens when a police officer, doctor, care professional, or family member requests, and is then granted by a judge or magistrate, an order to have a person admitted to inpatient care against their will for the sake of their (and others’) safety. To meet commitment criteria, you need to be:
- In danger of harming yourself because of mental illness;
- In danger of harming other people because of mental illness; or
- In danger of harm from being unable to care for yourself due to mental illness.
You can meet these criteria if you have a suicide plan, have stopped caring for yourself in a way that puts you in danger, or have physically attacked or threatened to attack someone. (Note that just being belligerent is not enough; your behavior has to be due to a mental health condition.)
For more information about how this process works, you can read our article “Involuntary Commitment: When and How to Do It.”
The good news is that it’s not that hard to get admitted to inpatient treatment if you’re at risk of harming yourself or others. The bad news is that you may or may not be able to get inpatient care if your mental health crisis doesn’t quite rise to that level. Whether you qualify for inpatient admission depends on where you are and the availability of care in your area.
If you’re not sure whether your symptoms are severe enough to go to the hospital, don’t assume anything until you talk to someone first. If you’re in crisis, it’s important to get help as quickly as possible. And the best way to do that is to call a mental health hotline.
Who Do You Call When You Need Inpatient Mental Health Care?
If you’re in crisis, and you’re not sure where to go or who to call, we recommend calling either:
- Your local (or regional) mental health crisis line, which you can find on our page for your state’s mental health system,
- The National Suicide Prevention Hotline at 988, or
- Another crisis hotline that specifically addresses your situation or needs.
The National Suicide Prevention Hotline, local mental health crisis lines, and many other mental health hotlines can identify and connect you with local crisis resources. They can then guide you through the process of getting where you need to go to get the right level of care.
How Long Does Mental Health Treatment Last?
Let’s say you’ve sought admission to an inpatient treatment facility, and you’ve been accepted. What should you expect when you arrive?
First, don’t expect to be there too terribly long. A 2012 study found that the average length of inpatient treatment for people with serious mental illness was 7-13 days. A 2004 study found that the average length of stay was 15 days and “absence of serious mental illness was significantly associated with shorter length of stay.”
Depending on why you're admitted and how quickly you respond to treatment, you might be in the hospital for as little as two or three days.
The reason psychiatric hospital stays are so much shorter than they used to be is because inpatient mental health care has a different purpose now. In the past, psychiatric hospitals were places where people went to get long-term care because it wasn’t yet possible to manage their conditions outside of an institution. Now, psychiatric hospitals are for acute care, or intensive short-term treatment that improves your condition to the point you can be discharged and continue your treatment on an outpatient basis.
Where Exactly Do You Go for Inpatient Mental Health Care?
If it's your first time getting inpatient care, or if you've received short-term inpatient treatment before and responded well to it, you'll probably receive care at a general hospital with a psychiatric unit or at a standalone private psychiatric facility that is part of a major hospital system in your area.
It’s possible to call a psychiatric unit or hospital and ask to be admitted voluntarily. You may have a local hospital with a mental health unit, or you may need to travel to one that does.
Depending on your symptoms and situation, the hospital may ask you to bring yourself or have a loved one bring you to the facility. Otherwise, you’ll be admitted through a local emergency department (ED), where you’ll wait under safe supervision until space becomes available at a mental health unit or facility.
(If you’re involuntarily committed, you may need to be transported to the ED by law enforcement, depending on regulations in your state.)
Watch Out for Wait Times
Unfortunately, due to demand, you can sometimes wait for a long time in an ED to get into an inpatient facility—sometimes for several days, though usually for one day or less.
State psychiatric hospitals still exist, but they’re not where most people get inpatient treatment anymore, especially not the first time they go. These large facilities are often reserved for forensic patients—people who have been admitted through the criminal justice or corrections systems.
If you’re not involved with the criminal justice system, you’ll probably only ever go to a state hospital if you have a severe mental health condition, didn’t respond to an initial episode of acute hospital care, and need longer-term treatment (often 30 to 90 days) to stabilize. (Note that most states have separate facilities or units for forensic and non-forensic patients.)
What Is Inpatient Mental Health Treatment Like?
What do hospitals do to help you get better?
First, they may prescribe psychiatric medication. The clinical staff may recommend that you start taking medication on a long-term basis, or they may simply want you to take medication on a short-term basis to help you stabilize in the hospital.
Or they may not recommend medication at all. It depends on your condition, your preferences, and your history.
What Do You Do in the Hospital?
Whether you receive medication or not, you’ll usually participate in:
- Group therapy sessions
- Individual therapy sessions
- Therapeutic activities like art, exercise, and yoga
Group therapy sessions can be educational, therapeutic, or both. Their goal is to help you understand your symptoms and learn how to manage them. They will also help you and others in the group feel seen and understood. This can help you accept yourself and your condition and start to heal.
Individual therapy in an inpatient unit helps you analyze the conditions that led to your mental health crisis and hospital admission. These sessions can help you gain insight into what happened and how you can recover. They will also help you and your clinical team put together an effective discharge plan and identify goals for ongoing therapy in the community.
Therapeutic activities are designed to help you feel calm and grounded. During a mental health crisis, your nervous system is overwhelmed. Soothing activities can help you heal your nerves, regain your ability to focus on the present, and become better able to participate in and benefit from other therapeutic interventions.
What Are the Downsides of Inpatient Mental Health Treatment?
While psychiatric hospitals and units have moved past many of the horrors we once associated with them, it’s fair to say they can still sometimes be scary places to be, especially if you’ve never been to one before.
Psychiatric units and facilities treat a wide range of patients. This means a severely depressed person who cringes at how loud a shuffling newspaper sounds can be put on the same unit as a person experiencing a psychotic episode who is screaming at the top of their lungs.
The fact that psychiatric units gather people together who are having some of the worst times of their lives can make them stressful places to be.
At any kind of hospital, you might be around people who are crying, yelling, or in distress, and might feel a certain sense of sadness or claustrophobia.
To maintain the safety of everyone on the unit, both medical and psychiatric hospitals still use restraints sometimes. However, their use is highly regulated and hospitals can lose their licenses if they use them inappropriately or too much. Don’t expect this to happen, but understand that if it does, it’s to keep everyone safe.
Remembering why you're at the hospital can go a long way to allay your discomfort with the unfamiliar setting.
You might actually enjoy your experience on a psychiatric unit, or you might not. But whether you enjoy your experience, remember that your team is working hard to help you get better and get you back home.
What Happens After You Leave the Hospital?
From the moment you're admitted to the hospital, your clinical team starts working on your discharge plan. Think of the hospital as a way station that gets you from the crisis point that brought you there to a place where you can get the treatment you need in the community.
In rare cases, psychiatric hospitalization is all that is needed to fully resolve a mental health crisis. However, it’s much more likely that you’ll need ongoing outpatient care after leaving the hospital so you can manage the condition that brought you there and so you don’t need to go back later.
For example, if you went to the hospital to get treatment for a major depressive crisis, your clinical team might recommend that you start taking an antidepressant medication and follow up with a physician at a community mental health center or primary care clinic. Instead, or in addition, they may recommend therapy and give you a referral to a private practitioner or a therapist at a local counseling agency.
Depending on your circumstances, your team may recommend additional treatments. They might encourage you to attend support groups or to follow a nutrition or exercise plan. If you have any co-occurring conditions (such as medical or substance use disorders), they will refer you to providers or programs who can help you address them.
The important thing to keep in mind is that your discharge plan is designed to keep you stable so you don't have to come back to the hospital or go through another mental health crisis. So please take your team's advice and follow their recommendations!
Your new outpatient mental health team might tweak and update your plan as they learn more about you, but they will start with what’s on your discharge plan. Following that plan and getting good follow-up care is essential for getting on the road to recovery.
Conclusion
We hope the information that we’ve provided in this article will help you recognize if you ever need to go to the hospital, understand what you’ll experience there, and be ready to reach out for the care you need if you’re ever in crisis.
Going to the hospital when you’re having a mental health emergency might help you get better faster than you otherwise would have. It might even save your life.