Depression Hospitalization Primer?
October 30, 2015 11:17 PM   Subscribe

As my life unfolds, there is in the short term a growing likelihood I may need to seek residential treatment / hospitalization for major depression. I’m finding it very hard to do research, as most easily accessible search engine results appear (to me) to have been gamed or SEO’d, and what few respectable websites I do come across are barebones or tight-lipped. Perhaps this is because of a wider turn from institutionalization or residential treatment. But still I have questions, and I’d be grateful for any insight...

I’m a serial planner, and knowing about potential plan bs or plan cs is calming for me. For complex, special snowflake reasons, if my current academic situation resolves poorly I’ll be kicked out of college with nowhere to go. And even if I can graduate, these episodes seem to persist at such a rate as to perhaps impact future careers. I have pursued years of therapy and medications, I’ve even taken time off to seek outpatient care at the University of Michigan Depression Center (I'm in New York state now). My periodic darknesses seem to only be becoming fuligin. While I’m “fighting” as hard as I can (although illness as a metaphor etc etc), there is a non-zero chance that i’ll lose this round or maybe the next. If that is the case, I think the best course of action is to check myself into a facility. I hate this, I don’t want to do it, but it isn’t smart to pretend like its an impossibility.

I don’t really have the energy for a phenomenology of my intraconscious horror. For the purposes of this question I don’t think much more biographical detail is necessary, but should it help: I have several complex childhood traumas that feed into the depressions, and I'm queer which always seems to matter just when I think it shouldn't. The unfortunate reality is that this move would be one to protect myself from disastrous self-neglect and the real probability of further self-harm or worse. While I realize I’m not being all that articulate right now, I’m told I’m a fairly bright person and although my life circumstances have foreclosed most academic/prestigious pathways, I'm personally not sold on those being cruise-control for meaningful existence and also still think I can find ways to contribute to the world, either through activism, communal work, or ideally through writing. I want a future and I’m committed to making sure I can build one for myself. But hospitalization seems inevitably like the least worst option if things (continue to) fork in a certain direction.

To that end, I’m soliciting an advice or recommendations on the issue: things to read, personal experiences, particularly outstanding programs, or experimental treatments you’d encourage or think I should veto to the best of my ability. My most specific desire is for recommendations of places: I’m not tied to any one area right now, and I feel really overwhelmed by not even knowing where would be a good place to go. Assume I'm so ill-informed that my cultural antecedents for the internal command "imagine mental health hospitalization" are fin de siecle sanitariums, teenage jaunts through abandoned asylums, and emergency rooms. This needs to change.

I also have shallow concerns, but they feel important to me:

1) I’m a silly snake person — what is internet access like at these places? I understand its probably a “varies” answer, but in general? I like the internet a lot and its been a lifeline for me many a time
2)Reading is a huge part of my continued living. Will I have time to do it? Will my choices be restricted or like pre-screened? Can I even have materials sent in or must I bring a large stockpile of books?
3)Whats the deal with potential travel? Once I’m in, are there ever furloughs or like “time out” for, say, a dear friend’s wedding or day trips to art shows?

Deeper concerns:

To what extent will I be allowed to research my own treatments while there? A huge, helpful part of my out-patient treatment at the UMich Center was the team of doctors actively giving me relevant books and studies and guiding me through the processes of different treatments. It built immense trust.

I anticipate insurance may come up. While I can’t provide details, I’ve purchased healtcare through the year. However, if it doesn’t cover these sorts of things and its something i would need to go into debt for, I’m willing to do this (don’t really need assets in the non-capitalist economy of being dead) and if so are there places internationally I should consider? Since this is an information seeking mission with a "calming fantasy” aspect to it, I really ok with at least pretending in the direst times I could go anywhere / try the best, most experimental, or most interesting but controversial programs.

(As a side note: I read Noonday Demon a few years ago, and am familiar with some more literary grapplings with depression, and during a period of misdiagnosis, most relevant bipolar literature. But as mentioned earlier, there is a positive/quietist facet of my compulsive reading, so any books you’ve found insightful or helpful or that deal with hospitalization for depression would be lovely)

I’m also interested in or open to critiques of (yours or published) residential/in-patient treatment, but mainly I’m just so lost and I hate that feeling. I hope the hive mind can help generate a little mini-primer, or set me on the right path, or just provide any sort of guidance. My therapist is doing a little research himself, and will get back to me, but is very much a “think on the bright side” fellow.

I realize this question got rather lengthy, I can be wordy in fear, but any contributions or answers to any subfield are valued.

Thank you for taking the time to read this. I hope you’re having a good day,
posted by anonymous to Health & Fitness (10 answers total) 6 users marked this as a favorite
Hi. I was hospitalized for a depressive episode a decade ago.

One of the very best things that helped me? I had a friend be a gatekeeper for the social media. She gave people updates, and in turn let me know what people said. That proved to be helpful to me, as I could concentrate on my own healing, and not worry about communicating with the outside world for a little while.
posted by spinifex23 at 12:37 AM on October 31, 2015

My only experience is with mixed-treatment facilities, so YMMV.

You should be aware that if in-patient care is covered by your insurance, you will probably need a referral; it's not the sort of thing you typically just book yourself into (although you can). Otherwise your out-of-pocket costs are likely to be around $10,000 for 7 - 10 days in-patient, though this is an average and NY will be higher. Also note that a lot of programmes are 30-day minimum but this is all generally dictated by insurance.

So while you are looking for facility recommendations and say you are not tied to any area right now, it will be in your own best interests to use your reading and research energy to research your insurance, coverage, and in-network facilities. (And I actually think it's really helpful to have a set list of facilities to look at, limited by your insurance, rather than working from a list of Every Place in the World.)

1) Most facilities are mixed, so providing people with internet access to pro-ana websites, texts from their dealers, and Facebook photos of their drinking buddies, you know, drinking, is anti-therapeutic. But some facilities do provide daily device time, and in some it is an earned privilege for treatment compliance.

And a lot of your work will be focused on developing your own lifelines, so there is that.

2) You will have time to read. You can likely have books sent. They may be searched, particularly if you facility also treats people with co-presenting addictions. Books may be restricted; it really depends on the facility.

3) In-patient treatment is really intense. And safe. And self-focused. And functionally secluded. The first day I was allowed out, I was utterly overwhelmed by the outside and turned around and walked right back in.
posted by DarlingBri at 12:45 AM on October 31, 2015 [1 favorite]

There’s a little bit about in-patient treatment for major depressive episodes on Scott Alexander’s blog post about treatments for depression here. He’s a psychiatrist-in-training in the US.
posted by pharm at 3:44 AM on October 31, 2015

Send me an email at my I recently (4 weeks ago) left an intensive inpatient treatment center after 10 days. I've been in an Intensive Outpatient for the last 4. Here's some highlights.

1. It's all in where you are. Where I was had one computer, no printer, that we were allowed to access whenever.
2. I was able to use my cell phone twice a day, but in a secure area as photos of the staff are bad and will not keep them safe as they treat the best and worst of us patience.
3. Food: Chicken Fingers, every meal.

Bonus points if you are in Massachusetts. I'm now very well versed with the in/out patient treatments here. In fact, due to my own issues (and not the treatment), I'll likely be visiting them again soon.

Honestly, feel free to reach out to me at the email address I mention above (Draccy at gmail). I'll be happy to answer any questions and will honor your privacy above anything else. Stigma sucks, and I get that you may be trying to avoid it.

The struggle is real, my friend. Don't you dare give up.
posted by Draccy at 6:04 AM on October 31, 2015 [3 favorites]

My experiences with inpatient mental health treatment are from a clinical standpoint. There are two inpatient psychiatric hospitals where I live and both facilities will allow you to sign in voluntarily. To the best of my knowledge, neither facility will allow you to have access to the internet. As far as I know they will confiscate your phone, ipad, etc because they don't want outside sources influencing your treatment. As far as insurance not covering your treatment there may be a community mental health entity where you live that can assist with funding. A quick internet search found

Unfortunately there is a stigma associated with mental illness but you know what? Fuck that nonsense. Anyone who has struggled with depression knows that you don't just "snap out of it". If only it were that easy. Keep on keeping on. You got this.
posted by cdg7707 at 10:13 AM on October 31, 2015

Other treatments to consider: transcranial magnetic stimulation, abbreviated TMS. It's a no-contact electrical charge to portions of your brain—not ECT, not an implanted stimulator.

I looked for evidence on its effectiveness in bipolar and found almost nothing, but there are many small trials showing improvement in depressed patients who've not responded to pharmaceutical treatments. My shrink said one really has to go off all meds before trying TMS, and a hospital is a good place for that.
posted by Jesse the K at 10:47 AM on October 31, 2015 [1 favorite]

Take a look at Cooper-Riis. It is very different from the usual program but fantastic if it is a good fit for you. It is a residential program, but very different from the medically-oriented, short term focus of the typical hospital based program. Instead it looks at the whole person and seems to be very effective at healing the deeper wounds that can drive mental illness. They helped a family member and it was absolutely life-changing (in a good way) and in ways that would never have happened embedded at home. (Cooper-Riis offers a combination of really friendly, supportive people plus interesting meaningful actives during the day without all the complexities of your current every day life.

- The philosophy emphasizes you as a whole, complete person, not as a patient. There is a mix of staff, resident volunteers, and regular residents will minimal distinction. (Some staff live in apartments on the property and eat in the same dining hall)
- Everyone helps out - usually basic work like kitchen prep or gardening that gives you the opportutity to be productive, even if your head is a bit foggy. And you are having a bad day and can't, that is OK too.
- Internet access is in the main building. I think cell phones and laptops have to wait until they see how you are doing. As far as I know, no limits on reading.
- Travel requires approval of your team.
- The psychiatrist that we was there then was amazing - got rid of a bunch of stuff that had accumualted over time without doing anything, added some supplements to increase the effectiveness of the more powerful stuff on a lower dose, ordered some genetic testing that opened up a whole new solution and generally knew his stuff (and was also a good listener and willing to work in cooperation with the patient instead of being a know-it-all.
- It is expensive, although much less than a hospitalitzation. There are scholarship opportunites after you pay for the first month.
- If you want to talk to someone who has been there, memail me and I can put you in touch with them.
posted by metahawk at 2:54 PM on October 31, 2015 [1 favorite]

Inpatient treatment and residential treatment are incredibly different - the first is locked and aimed at monitoring people who are risks to themselves/others, while the latter is more open ended. Residential care is more open ended and concentrates on psychotherapy and lasting change. If you need inpatient care, you're in no position to travel or be picky (though if you want to show up to the Mayo Clinic's inpatient center, I can vouch they're a very good program and one of the most liberal I know about computer and cell phone use - it was unlimited and there was a computer lab there too).

Austen Riggs Center and The Menninger Clinic are the two most well regarded residential facilities. They don't bill insurance and treatment is like $1k/day. Sidran's help desk (Sidran is a great web resource on its own) maintains a list of residential trauma treatment programs and suggestions on how to evaluate them. You can email them and get personalized advice, or just their list. Best of luck. It goes without saying that you can memail me.
posted by sweltering at 4:42 PM on October 31, 2015

MeMail me.
posted by granted at 3:06 PM on November 2, 2015

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