What should I expect when seeking inpatient mental health treatment?

February 20, 2009 12:51 PM

What happens if you check into an inpatient psychiatric facility in Maryland/ Washington/ Virgina?

I'm considering seeking inpatient treatment for depression. I'm not on the brink of suicide or anything, but I'm afraid of getting to that point... I'm scared and depressed and confused and overwhelmed and thinking I probably should not be alone all weekend.

If I check myself in to a hospital:
-will I be able to choose when I leave? (On what basis could I be forced to stay?)
-will I be forced to take whatever medication is prescribed, or will I have some control over my treatment?
-are some hospitals "better" than others? (I would be grateful for specific recommendations in the DC metro area.)
-am I overlooking other options? Is there some kind of emergency outpatient counseling I could get?

Thank you in advance.

posted by anonymous to health & fitness (15 comments total)

i've no real specific advice for you, only to say that i'm glad you're considering getting help and strongly urge you to do it. heather armstrong of dooce checked herself in for a month a few years ago because of chronic anxiety and depression and not taking her medication, please read her post about the importance of getting help and go!
posted by lia at 1:01 PM on February 20

If you're up to it, please MeMail a moderator with a separate throwaway email account so that people can contact you with advice anonymously. I'll bet you could get a lot of really useful advice privately from AskMe members who are shy about posting under more public accounts.

Anyway, I used to know a bunch of people who worked at what is often called the best psych hospital in Maryland, (#7 in the country, thought of as specializing in young adult trauma patients) and they were all very cool people, but they often indicated that their style was at odds with other hospitals' at times, in ways precisely related to the level of agency they gave patients who were at risk. What I'm saying is that there are a number of options depending on what exactly your background and experiences are. Your best bet is to talk to a therapist or just a hotline operator about exactly what you're feeling and afraid of and they can make a recommendation.
posted by Potomac Avenue at 1:22 PM on February 20

The following presumes you are not a minor. Also, IANAD or a mental health professional.

Will I be able to choose when I leave?

Yes. Check with your insurance company before you do; they may not pay the full amount if you leave against medical advice (AMA). Be aware that they will have rules about behavior, such as not leaving the floor, not leaving the hospital without permission, etc. This is for your own safety. But you can always say that you don't want to be there anymore and pack up and leave. No one is going to forcibly restrain you into staying.

On what basis could I be forced to stay?

If you are a danger to yourself or others. Generally they don't consider you an imminent risk unless you have a plan. While you're there, it'd be pretty difficult to carry it out, anyway, as they'll take away most anything you could use to harm yourself.

will I be forced to take whatever medication is prescribed?

No. They should discuss options with you, and let you make an informed decision about what you want to take and whether you want to take anything at all. I was inpatient when I was 15 and they recommended medication but did not force me to take it. If they can't do that to a minor child, they can't do it to an adult (unless you're imprisoned).

I don't live in the area and can't recommend any specific hospitals. If you have any friends who see psychologists/psychiatrists, perhaps have them ask their doctor. Or ask your general physician. I have been able to get emergency appointments with psychiatrists by calling and saying that it's an emergency (it's usually the next day, though, so if it's a real emergency, go to your ER).

Normally inpatient clinics also have some outpatient treatment. They will do sort of a triage interview to determine what's best for you. I recommend taking a supportive family member or friend with you when you check in. It can feel terribly lonely.

Best wishes to you, sincerely. If you have any other questions please feel free to email me.
posted by desjardins at 1:29 PM on February 20

Btw, the above is based on my own experiences as a teenager and those of my mother, who has been hospitalized multiple times for bipolar disorder.
posted by desjardins at 1:30 PM on February 20

WOAH. Slow down.

A friend of mine checked herself into a psych facility in NYC for depression. After a day of living among the real crazies, she realized this was not actually going to help her in the way she needed. She was forced to stay against her will, and unable to leave until the facility had evaluated her. Which took a week.

I would find out what the details are for your specific facility before you walk up to the front desk with your suitcase. And I really encourage you to explore other options as well... public mental health options in the U.S. is eye-opening, to say the least.
posted by danny the boy at 2:03 PM on February 20

Sorry, by other options, I mean other options that don't necessarily involve committing yourself: therapy, hotlines, etc. as was mentioned above by Potamac. Please do seek help. Good luck!
posted by danny the boy at 2:07 PM on February 20

The first chapter of Pete Earley's book Crazy (read the first chapter online here) recounts the author's attempt to have his son committed to care in Virginia. In a nutshell they state that unless he's an imminent threat to himself or others they can't treat him against his will.

The implication is that there would have been no difference if his son had changed his mind a day later rather than right then, but obviously this is an anecdotal account from a few years back. I'm unaware of any changes made after the VA Tech incident - many were discussed but I don't recall any happening - but I can't state authoritatively.

Good luck.
posted by phearlez at 2:16 PM on February 20

public mental health options in the U.S. is eye-opening

Yeah, definitely don't go to your state/county hospital if you can possibly avoid it.
posted by desjardins at 2:22 PM on February 20

By the way you phrase your question, it sounds like you haven't sough outpatient help yet, for example at your local ER or otherwise. Seeking outpatient help first would be a really good way to get great answers to these questions, and perhaps give you some immediate help. I have been surprised in the past by how much one conversation with a good therapist or psychiatrist can help, not to mention anxiety meds that frequently act immediately. While not a good fit for everyone, it might be something to think about.

But having said that, I am neither a doc nor any kind of psych professional, and you know you best. And of course, if I am wrong in my assumption, well...

If there is a close friend or family member nearby you can call upon, that might help too. Even if not, you are NOT alone, and if you need someone to talk to (confidentially), please feel free to MeMail me or as suggested act through a mod to put in a throwaway email address. You are very wise and very brave to recognize these problems before they overwhelm you utterly, and I commend you for it.
posted by bunnycup at 2:24 PM on February 20

On what basis could I be forced to stay? If you are a danger to yourself or others.

Right, but this is a highly subjective decision, and sometimes you can effectively be forced on medication by the argument that if you do not medicate, you will be a danger to self/others. This is a catch 22 because then deciding not to medicate means that you can be kept for longer. Know what you're getting into, and do some research into the specific institution. Remember that being confined around a lot of seriously mentally ill people is not necessarily pleasant or healthy.
posted by sidr at 3:03 PM on February 20

Yes, even a voluntary commitment will have a 72 hour holding for evaluation period. During this time the hospital will decide whether or not it is necessary to hold you involuntarily once 72 hours expires, which would be the decision of a mental health court judge, oftentimes on the facility grounds. If you are not suicidal, it's unlikely that they would even admit you inpatient. They would more likely refer you to outpatient resources in the community better suited to someone who doesn't need such a high level of care and observation.
posted by The Straightener at 3:05 PM on February 20

Firstly, slow down.

Being scared, depressed and lonely does not automatically mean that an inpatient stay is indicated. In all honesty, without suicidal (or homicidal) thoughts it is far from certain that they will even admit you. In my experience, more extensive than I care to admit in a public forum, inpatient psychiatric units are geared towards defusing crisis situations.

My advice, for what it's worth, would be to start with your local outpatient mental health clinic (there is a hotline number in the community resources section of your phone book) and schedule yourself for an intake. At that point a professional can determine the level of care needed and the best way to obtain it.

Will I be able to choose when I leave? (On what basis could I be forced to stay?)

Yes. You can leave when you want unless you have been legally committed. It would require a judge, a couple of doctors and your local DSS (Department of Social Services) all agreeing before a forcible commitment was even an option. Unless you have indicated a desire to harm yourself or another it ain't gonna happen.

Will I be forced to take whatever medication is prescribed, or will I have some control over my treatment?

You cannot be forced to take any medication or accept any form of treatment against your will. However, be aware that once you enter treatment compliance with the treatment teams recommendations is expected.

Are some hospitals "better" than others? (I would be grateful for specific recommendations in the DC metro area.)

You bet. Insurance is going to be a huge factor. Keep in mind that Medicaid is often better than private insurance when in comes to substance abuse and mental health treatment.
posted by cedar at 3:16 PM on February 20

This isn't really an answer to the question -- but if you ARE going, is there someone you can call to go with you? A friend or an acquaintance, who might be able to intercede on your behalf?

I have a friend who voluntarily committed himself to the psychiatric ward at Union Memorial in Baltimore after threatening suicide -- I didn't know him well at the time, but he was cognizant enough to realize that psych wards are kind of scary and alienating, and he called up a few people to just sit with him. It was a remarkably easy thing (for me) to do, and I think it helped him a lot. Looking back, this was probably pretty scary, since we didn't know him well --- but it wasn't a big deal at all. Maybe a friend, or even a neighbor? (if you're in school, it could be your RA, etc)

If you need to go to the hospital, you should go -- and asking someone to take you is a pretty small thing, that might help a lot if you're scared -- especially if you're worried about having to negotiate bureaucratic stuff in a tense emotional state.

I'm from the Baltimore area, but I don't have any specific recommendations on hospitals, other than that Shephard Pratt has a good reputation, and the two people I know where were (involuntarily) committed there (as teenagers) hated it.

Take it for what it's worth.

I really hope you feel better. Feel free to send mail if you want to talk more, and lots of hugs.
posted by puckish at 4:34 PM on February 20

Also, this link might help.
posted by puckish at 7:13 PM on February 20

Inpatient treatment is generally seen as a last resort because treating people in the least restrictive setting is not only cheaper, but generally more effective and comfortable.

but if you need it, you should not hesitate to go. It sounds like you have insurance so if you can possibly do it, call your insurer and tell them it's a psychiatric emergency and you need an immediate referral to a psychiatrist who can see you tomorrow.

If you have friends or family you can stay with, arrange for that-- you'll likely get to see a psychiatrist within a day and they will assess you and help decide whether to start you on meds, therapy or ideally both and whether inpatient is needed. Have someone else make the calls if you don't feel up to it-- most people enjoy helping their friends so it is OK to ask.

If you don't have insurance, unless you are imminently suicidal or homicidal or wealthy, hospitals are not likely to admit you-- it is expensive. That doesn't mean you shouldn't seek help at an ER right away if that's what you need to stay safe-- but definitely, if you do that, bring someone with you if at all possible.

Although most people think cost is the only reason inpatient treatment is limited, it actually is generally not very good for doing anything other than keeping you from killing yourself: it's an alien, controlling environment at a time when what you most need is familiarity, emotional safety, love and support. There's no evidence suggesting that keeping people in for long periods is helpful, which is why advocates for the mentally ill generally support keeping inpatient limited to the briefest possible period for stabilization and doing most treatment in the community when at all possible.

So, if you can create a safe place with people who care for you around you (and even though you may not believe this because of your depression, people genuinely *do* tend to care), it's better to do that while you wait for the meds to kick in and start therapy.

Of course, if you feel like you are simply not safe right now, go right away to the ER...
posted by Maias at 7:15 PM on February 20