Checking into a psych ward in the San Francisco Bay Area
September 20, 2009 8:00 PM   Subscribe

I know someone who may want to check himself into a mental hospital in order to work out some personal issues. He's really depressed and anxious and falling apart. Where is a good place to go in the San Francisco Bay Area? Does anyone have any experience with this? How long can they keep him there? Can he check himself out? (Assume he is not an immediate danger to self or others and not psychotic.) What kind of treatments can they subject him to? Does he have to pay if he has insurance? If he doesn't have insurance? Does it depend on the diagnosis?
posted by anonymous to Health & Fitness (9 answers total) 1 user marked this as a favorite
 
Call 415-781-0500. It's a crisis hotline for the Bay Area. Even if he's not suicidal, neither you nor he has any way of assessing that. One or both of you should call the crisis line and inquire with them as to the right approach.
posted by JoshSmith at 8:55 PM on September 20, 2009 [2 favorites]


His insurance company is really the only one who can tell you what they'll cover. Insurance covers inpatient hospitalization either totally or just a percentage or not at all, depending on the insurance company and type of coverage, so no one can really advise you on that 100%. He should call the company and give them the details of his coverage type, then ask them what's covered.

If he's going into the hospital voluntarily, they can't actually "keep him there" unless he gives consent to be there, so the length of stay depends on the treatment he needs and is capable of affording. Yes, he can check himself out if he is an adult and he enters voluntarily.
posted by so_gracefully at 9:07 PM on September 20, 2009


Also, the insurance company can probably give him some referrals for hospitals/facilities that are most likely to be covered.
posted by so_gracefully at 9:09 PM on September 20, 2009


Not sure about your state laws, but if he is deemed a risk to himself or others (primarily a risk of physical violence against self or others) he probably can be held against his will. It is generally only used in the more dire situations. I would research involuntary commitment in your area. But basically, if they were to involuntarily commit him, they would have to have very good cause.
posted by nursegracer at 9:23 PM on September 20, 2009


I have no experience with private psychiatric care, but I recently did a nursing school rotation in a Bay Area, public, psychiatric hospital. What I understand from that experience is that no, he will not be kept against his will unless he is thinking of harming himself or someone else, or unless he is "gravely disabled" ie: truly cannot care for himself. Additionally, he has the right to a legal challenge if he is being committed against his will. As for duration, in California you can be held for 72 hours against your will (if you are a danger to self or others or gravely disabled). I know you're talking about someone who voluntarily is looking for help, so this stuff probably won't be so important for him.

In terms of care, I think most facilities would offer a combination of medication (probably anti-depressants in his case) and some amount of group and/or one-on-one talk therapy (I imagine private institutions offer more talk therapy than do public ones). There are Bay Area hospitals that offer electroconvulsive therapy (ie: electroshock) to people who have intractable depression that has not responded to pharmaceutical treatment. But this is considered a last resort treatment and would not be done without consent.

I don't know what your friend needs exactly - maybe there are alternatives to hospitalization that would be more helpful? But if he's really in a crisis, perhaps hospitalization is warranted? Is he already seeing a psychiatrist? Because this is the person who could a) help him assess where he's at now and b) explain the specific, available options.

I'll add that if I was seriously depressed, I most certainly would not want to go to a public psychiatric hospital for help as its a very sad place with little therapeutic care. I guess the exception would be if I was truly thinking of killing myself or someone else immediately. in that case, the psych hospital could keep someone out of trouble and provide medication for a couple days until (hopefully) their mood stabilized enough to seek care elsewhere.
posted by serazin at 11:31 PM on September 20, 2009


It is very sad that so_gracefully is so right--you ought to check with his insurance carrier before seeking medical attention to be sure the bills will be covered. However, having dealt with insurance companies before, this will likely be a nightmare. The treatment he is seeking is expensive. My strategy has usually been to go get the care I need, and then fight like hell to make them pay for it (this does not always work). Most insurance companies have websites where you can email in your complaints (and this definitely works better than phone calls).

Anyhow, I think it's great a) that he has someone like you posting here, and b) that he's in a place where he can recognize that there are substantial issues that need to be addressed. But I'm really feeling like you should just grab a cab and head here immediately.

Best of luck to you both.
posted by ohyouknow at 11:33 PM on September 20, 2009


Several years ago I did Assessments and Admissions for an inpatient, private psych hospital, so this is from my experience. However, this was NOT in California, and was a good 5 years ago, so I'm sure prices and insurance coverage are different now. YMMV, IANYAdmissionsPerson, etc.

If he's not an immediate threat to himself or others (suicidal/homicidal/delusional) he should call his insurance company and ask about his Mental Health benefits (or I guess he could find that on his insurance website if he can log into his specific policy). Ask for inpatient, outpatient, and "partial hospitalization" (where he can go to an intensive program or the inpatient groups during the day, but go home to sleep at night. It's between inpatient and outpatient in terms of intensity). They should be able to tell you what his copay and coinsurance is, along with how many days they cover and how many outpatient sessions they cover. Ask about the deductible...some insurance companies have a separate mental health deductible that is not the same as the medical deductible.

Generally, there are several factors that determine length of stay. Obviously if someone is a danger to themselves or others, they cannot let him leave. That is the judgment of the doctor and the staff. So, severity of symptoms plays a role in length of stay. Insurance coverage plays a role as well. Some insurances I worked with (after I did the assessment and determined if the patient needed admission, I would have to call the insurance company to get the admission pre-certified so they would pay for the first 24 hours) were very strict. If the patient did not state that day that they were having suicidal thoughts or actively hallucinating, the insurance wouldn't pay, which in my opinion was a crock of crap. Some insurances made the determination based on how well the person would function if sent home, so those were easier to convince to continue treatment. Mostly it depends on how the psychiatrist and therapist documents what's going on. Some doctors are really knowledgeable on what to write for insurance purposes, which made the job easier.

If insurance isn't involved, he can still admit himself if he's willing to pay for it out of pocket. The hospital I worked for quoted a private pay rate of around $4000 a day, but that could be negotiated. Payment plans were also negotiated, but they would always want something up front. If he's paying cash, he quite possibly could stay for as long as he was willing to pay...I've seen it happen.

Treatment in an inpatient psych unit usually consists of a safe place to sleep (locked unit, monitored rooms, staff presence), group therapy during the day (3 or 4 group sessions with the other patients), a few minutes with the doctor each day, and a session with the therapist/social worker every other day. Meds are given out if prescribed, and there is usually plenty of recreation/leisure time. Depending on the issues, family sessions and addiction groups can happen as well. Expect quite a bit of downtime. The more he's motivated to work on his issues, the more benefit he'll get. The first 24 hours of an inpatient admission is the busiest because nursing has to do a nursing assessment, the doctor has to do a medical assessment, and the therapist has to do a social work/emotional assessment. All of those people contribute to the overall treatment plan goals set for the patient. Partial hospitalization means that the patient comes in the morning, stays on the unit to do all of the groups and stuff that the other patients do, but goes home to sleep. It's cheaper because you aren't taking up a bed, but not all hospitals do it.

I can't specifically recommend any place in California because I've never worked there. I'd call around and ask a few questions about the treatment they offer. Some focus specifically on making sure the patient is not at risk, then discharging them to do outpatient treatment. Some have a really intensive inpatient program designed to address whatever the problem is. Some might have different units in an attempt to separate the severely mentally ill from the "higher functioning" patients. They all should keep the drug/acohol addictions unit separate from the "psych only" unit because of different treatment approaches, but there can be some overlap.

If you have other questions, let me know. Each experience is different, so the above information is generalized from about 8 years of me working in psych facilities. Best wishes to your friend...I hope he finds effective treatment to get him going in the right direction.
posted by MultiFaceted at 11:49 PM on September 20, 2009 [1 favorite]


I second joshsmith -- please call the number for professional help and advice.

From the description of your friend's problem, it doesn't sound like he will be "committed" -- the bigger issue now is that psych wards/hospitals don't keep people in long enough because of insurance problems. However, if he/she does leave before the staff recommends it, he will be going AMA -- Against Medical Advice -- and insurance takes this as an excuse not to pay for the whole thing.

They can't "subject" him to very much without his approval, unless he goes totally batty and uncontrollable. They won't force electroshock on him or force him to take any meds, if that's what you're asking. At least they shouldn't!

Good luck to you and your friend . . . depression is excruciating, but there is a way out.
posted by imalaowai at 8:22 AM on September 21, 2009


If he's not an imminent danger to self or others, he's not going to get insurance to pay for hospitalization, except for perhaps a brief addiction detox on some plans. And, while that may sound horrible, in fact, it is often a good thing because for people with mental illness, being in a safe, familiar place around loved ones (often AKA home) is much more conducive to recovery.

The only really effective uses of residential treatment are for short-term medication stabilization for people who are imminently suicidal or homicidal, for habilitation of homeless people who don't know how to function, are uneducated and have nowhere else to live, for some cases of addiction (daily use of cocaine, heroin, alcohol, methamphetamine opioids, injecting-- nothing short of that) and for people who are truly so psychotic or have been through so many foster homes that there is no other setting where they can live.

Any closed institutional setting will tend towards at minimum, bureaucratic disregard of individual rights and needs, and quite often, outright abuse. Therefore, if you want to help someone recover from depression or any other mental illness, if there's any way to do it at home, do so.

Hospitalization isn't really designed to help mentally ill people-- it's designed to contain them. There's little evidence supporting the idea that inpatient hospitalization for mental illness does much at all other than habituate people to institutional routines. It's dehumanizing and often doesn't provide the active ingredient that is necessary to sustain recovery: long term, caring, supportive relationships.

You can have the best therapy and meds in the world-- and those things may be necessary, too, to initiate and sustain recovery-- but without ongoing social support, recovery is extremely difficult. This is why supportive housing that *isn't* a hospital, day treatment and outpatient groups are not only cheaper, but better.

So, if he's so depressed he cannot get out of bed to get to those things, and he's able to afford hospitalization long enough to start meds or ECT, it might be useful for that-- but it's unlikely to be much use in terms of actually helping solve the problem beyond that.
posted by Maias at 2:41 PM on September 21, 2009 [2 favorites]


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