Logan Reid
Psychiatric hospitalization, also known as inpatient treatment, is a process that involves 24-hour care and close daily psychiatric supervision in a hospital setting. This type of treatment is often considered when an individual is at risk of harming themselves or others, or when their mental illness severely impacts their physical health. The decision to undergo psychiatric hospitalization can be voluntary or involuntary, with the latter occurring when an individual is unable or unwilling to make the decision due to the severity of their illness. The length of stay in a psychiatric hospital varies depending on the individual's needs and progress, with the goal being to maximize independent living and improve functioning. Psychiatric hospitals offer various services, including individual and group therapy, medications, and intensive outpatient services, with the specific treatment plan tailored to the patient's specific needs.
| Characteristics | Values |
|---|---|
| Treatment | Close daily psychiatric supervision, 24-hour medical supervision, pharmacotherapy, nursing observation and care, individual therapy, group therapy, and other group or individual services |
| Patient Type | Adults, children, adolescents, forensic patients, prisoners, individuals with substance abuse issues |
| Admission Reasons | Risk of harming self or others, severe mental illness impacting physical health, failure of outpatient care, danger signs, treatment failure, need for physical restraint, inability to be managed safely in a less restrictive environment |
| Length of Stay | Average of 1.5 to 2 weeks for voluntary admission, longer for involuntary admission, determined by treatment needs |
| Discharge Planning | Includes referral to outpatient services, post-hospital stabilization, residential facility services, intensive mental health programs, chemical dependency programs, or community support services |
| Payment | Involuntary hospitalization may be covered by state funding; Medicaid and Medicare rules apply for institutionalized individuals and forensic patients |
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What You'll Learn
Risk of harm to self or others
Psychiatric hospitalization is a serious step, and it is generally considered only when all other outpatient service options have been explored. It can be voluntary or involuntary. In the case of the latter, a family member may have to make the difficult decision to hospitalize a loved one if they are at risk of harming themselves or others. This act is often an act of care and can be necessary, especially if there is a risk of suicide.
When an individual is hospitalized involuntarily, they must meet the legal criteria described in the relevant legislation. For example, in King County, Washington, adults must meet the criteria described in 71.05 RCW, and children in 71.34 RCW. During hospitalization, individuals receive a complete evaluation of their mental and physical health and a substance abuse screening. They then develop a treatment plan with hospital staff and professionals involved in their outpatient care. Family members or other interested parties may also have input in the treatment plan.
Voluntary hospitalization is also an option for those who are contemplating it as an option for themselves. It can reduce the stress of daily responsibilities and allow the individual to focus on recovery from a mental health crisis. Before entering the hospital, it is recommended that the individual creates a Psychiatric Advance Directive—a written legal document expressing their wishes about the types of treatments and services they want or don't want. This document can also be used to grant legal decision-making authority to another person, known as an "agent," who can advocate for them when they cannot make decisions.
Whether voluntary or involuntary, psychiatric hospitalization provides 24-hour care supervised by psychiatrists and provided by psychiatric nurses and group therapists. The goal is to maximize independent living by using the appropriate level of care for the patient's specific illness. The average length of stay in the hospital is 1.5 to 2 weeks for those admitted voluntarily and somewhat longer for involuntary admissions. However, the length of stay for voluntary patients is determined by their needs, and they may leave early if they decide to do so. On the other hand, a judge may determine the length of stay for involuntary admissions, with recommendations from the hospital regarding the patient's treatment needs.
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Negative impact on physical health
Psychiatric hospitalization is often considered when an individual's mental illness severely impacts their physical health. Here are some details on how mental health conditions can negatively affect physical health, leading to inpatient treatment:
Mental health disorders can have detrimental effects on an individual's physical health and overall well-being. This negative impact can occur in several ways:
- Neglect of Physical Health: People struggling with severe mental illness may neglect their personal hygiene, proper nutrition, and regular exercise, leading to physical deterioration. This can include issues like weight gain or loss, skin problems, or increased susceptibility to illnesses due to a weakened immune system.
- Chronic Physical Conditions: Mental disorders can exacerbate existing physical health issues or contribute to the development of chronic physical conditions. For example, depression has been linked to an increased risk of cardiovascular disease, diabetes, and stroke.
- Substance Abuse: Mental illness is sometimes accompanied by substance abuse, which can have severe physical consequences. Substance abuse can lead to organ damage, nutritional deficiencies, and an increased risk of accidents or injuries.
- Self-Harm and Suicidal Behaviour: In some cases, mental illness may manifest as self-harm or suicidal tendencies. This can include deliberate physical harm, such as cutting or burning, or attempts to end one's life. Hospitalization is often necessary in these cases to ensure the individual's immediate physical safety and provide intensive treatment for underlying mental health issues.
- Violence and Aggression: Certain mental health disorders may lead to violent or aggressive behaviour, which can result in physical injuries to oneself or others. Hospitalization can help stabilize the individual and provide a safe environment for them and those around them.
- Malnutrition and Eating Disorders: Mental health conditions such as anorexia nervosa, bulimia nervosa, or binge eating disorder can have severe physical consequences, including malnutrition, organ damage, and cardiac issues. Hospitalization is often necessary to address these physical complications and restore the individual to a healthy weight.
When an individual's mental health severely impacts their physical health, hospitalization can provide a safe and supervised environment for treatment. Inpatient care offers 24-hour medical supervision, ensuring the individual's physical needs are met while also providing intensive psychiatric care. The goal is to stabilize the patient's physical health and improve their mental health to prevent further decline or harm.
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Qualifying mental health diagnosis
Psychiatric hospitalization is often referred to as "inpatient treatment". It is a voluntary or involuntary process that occurs when an individual with a mental illness requires psychiatric treatment in a hospital setting. Qualifying mental health diagnoses that may require hospitalization include:
Risk of Self-Harm or Harm to Others
An individual may need psychiatric hospitalization if they are at risk of harming themselves or others. This includes exhibiting signs of danger to self or others, such as suicidal ideation or violent behaviour. In these cases, hospitalization can provide a safe environment and prevent harm.
Severe Mental Illness Impacting Physical Health
Hospitalization may be necessary when an individual's mental illness severely impacts their physical health and functioning. This could include situations where the person's condition has deteriorated to the extent that inpatient services under the direction of a psychiatrist are required to improve or stabilize their condition.
Acute Psychiatric Conditions
Acute psychiatric conditions, such as severe depression, bipolar disorder, obsessive-compulsive disorder, or substance abuse, may require hospitalization. Acute psychiatric hospitals or residential treatment centres are equipped to handle these situations and provide specialized care.
Inability to Be Safely Managed in a Less Restrictive Setting
Hospitalization may be considered if an individual's behaviour and symptoms cannot be safely managed in a less restrictive setting. This could include situations where outpatient services or intensive outpatient services have been explored but are insufficient to address the person's needs.
Forensic Patients
Forensic hospitals are specialized psychiatric facilities that serve individuals who are in the custody of penal authorities. These hospitals provide treatment for mental illnesses while adhering to the unique requirements of this specific patient population.
It is important to note that hospitalization is not intended to keep individuals confined indefinitely. The goal of inpatient treatment is to maximize independent living by providing the appropriate level of care for the specific mental health needs of the individual.
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Voluntary vs involuntary hospitalization
Psychiatric hospitalization can be voluntary or involuntary. Voluntary psychiatric admission occurs when an individual seeks psychiatric evaluation and agrees with the evaluating mental health provider that hospitalization is necessary and meets the criteria for hospitalization. There is no time limit on a voluntary inpatient stay. The individual may stay as long as they and the medical staff believe there is a continued need for inpatient treatment. The length of stay for voluntary persons is determined by their needs.
Involuntary psychiatric admission occurs when an individual does not agree to hospitalization but a mental health professional evaluates them and believes that they pose a "clear and present danger" to themselves or others due to a mental illness, or are unable to care for themselves. The patient will then be brought to mental health court within 5 days, and the court will determine whether the patient can be legally held on a psychiatric unit. The judge in a civil proceeding may determine the length of stay for an involuntary admission.
In the case of voluntary admission, the patient has the right to request a discharge at any time. If the patient requests discharge, the hospital can hold the patient for up to 72 hours until a mental health professional can evaluate the patient for safety concerns. The patient will be discharged if the evaluating mental health professional determines that the patient is safe. If the mental health professional evaluates the patient and believes that they are at risk of harm to themselves or others, or are unable to care for themselves, the admission can be converted to an involuntary admission.
In the United States, involuntary psychiatric admission is also known as a "302". Any person, including police and doctors, can petition or request an involuntary psychiatric evaluation for another person. The person requesting the evaluation is known as the "petitioner". If the petition is approved, the petitioner will be instructed on how to have the person transported to a CRC for an involuntary psychiatric evaluation (usually by police). The person will then be evaluated by a mental health professional who will determine whether they meet the requirements for involuntary admission to an acute inpatient psychiatric hospital. If a person is admitted involuntarily, they will either be discharged within 5 days or brought to mental health court within 5 days to request a longer commitment ("303").
Voluntary admission is also known as a "201" in the US and is available to anyone 14 years of age or older who is experiencing a mental health crisis and feels that an inpatient stay is necessary for their safety. There are no hearings required during this admission, and no information is submitted to the state police regarding the person's psychiatric treatment.
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Treatment plans and alternatives
Treatment plans for psychiatric hospitalization vary depending on the patient's needs and the legal requirements of the region. Inpatient treatment plans typically involve individual and group therapy, medication, and other services as needed. The patient's treatment plan should also include a plan for continued care after discharge, which may include outpatient mental health services, post-hospital stabilization services, referral to a chemical dependency program, or other community support services. The length of stay for voluntary hospitalization is typically determined by the patient's needs, while a judge may determine the length of stay for involuntary hospitalization.
In the case of involuntary treatment, the first evaluator must be a psychiatrist, and proposals and validations of involuntary admission are made by doctors. The patient may appeal the decision for up to three months after the termination of care. Involuntary treatment and hospitalization may be necessary when the patient is a danger to themselves or others, when their physical health is negatively impacted by their mental illness, or when they are incapable of self-care or self-regulation due to their mental state.
Hospitalization is generally considered an acceptable alternative after exploring all other outpatient service options. Partial hospitalization, for example, provides a structured program of outpatient psychiatric services as an alternative to inpatient care. This option is more intensive than regular outpatient care and may include occupational therapy, individual patient training and education, and support groups. Medicare Part B may cover partial hospitalization services if the patient meets certain requirements and a qualified mental health professional certifies that inpatient treatment would otherwise be necessary.
In some countries, such as Italy, Spain, and Sweden, the danger to oneself or others is not considered a criterion for involuntary treatment. Instead, they require the presence of a mental disorder and the "necessity" for treatment. In Denmark, the law recommends avoiding coercion, and admissions to psychiatric wards should ideally take place with the patient's consent.
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Frequently asked questions
Emergency room staff must decide whether psychiatric patients need to be admitted or can be treated on an outpatient basis. Factors that influence this decision include suicidality, dementia, and the patient's level of cognitive function, nutritional status, and ability to perform basic activities of daily living. Other factors include the patient's gender, the number of diagnostic procedures and consultations required, and whether the patient is accompanied.
Criteria for involuntary psychiatric hospitalization vary by country. In Portugal, a patient can be hospitalized if they have a serious mental disorder, are a danger to themselves or others, refuse treatment, or are incapable of giving consent, and their condition is likely to significantly deteriorate without treatment. In Italy, involuntary treatment is permitted for hospitalized patients, while other countries require a more detailed procedure to determine treatment options.
Inpatient psychiatric treatment at an acute psychiatric hospital may be necessary when an individual shows signs of being a danger to themselves or others. This treatment should not be used as an alternative to incarceration or as a means to ensure community safety. It should also not be used when less restrictive alternatives are available.
