When Should You Consider Being Hospitalized for Depression?

I wish psychiatrists sent people with depression home with instructions on when to go to the hospital similar to the ones obstetricians give to pregnant women once they reach 37 weeks of gestation: when your contractions last for a minute each and are five minutes apart, start the ignition!

“How did you know it was time to go to the hospital?” a friend asked me the other day.

“I didn’t,” I replied. “My friends did.”

Each psych ward experience is different. And no doctor judges the decision to enter one in the same way.

In hindsight, I wonder why my therapist didn’t urge me to commit myself months before I did. I talked about wanting to die most of my hour with her. Because it was all I thought about. That idea, alone, gave me relief. But I guess since I had been depressed for so long and hadn’t attempted suicide before, she felt I wasn’t a threat to myself.

16 Comments to
When Should You Consider Hospitalization for Depression?

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  1. I have a new friend who was making grandiose business plans and I made the decision to ask her if this was a good idea or was it her bipolar making the decision for her.

    She tells me it is her and not the bipolar and I asked her to consider it some more, do not part with any money and do lots of research before making a decision to go ahead.

    I just hope I planted a seed in her head because this was her third business idea in four months.

  2. Thanks, Therese. Nobody can tell it like someone who’s been there. I think your article will help friends and family better understand when to step in.

  3. Choosing the correct facility is also important as so many hospitals in my area keep a person asking for help overnight or for a day or two, precribe meds and send people back home. This can feel like rejection and be even more depressing. Good topic for discussion Therese.

  4. I regretted going inpatient. Worst decision I could have made. It was a very depressing environment and I left AMA. I thought the whole thing was very infantalizing, and being treated like a small child didn’t exactly leave me feeling more well.

  5. I think there are times when toughing it up, given one has some shoulder to lean on with their family or friends is the right thing to do. If going inpatient would seriously screw up one’s career/school/whatever… it may not be worthy. Yes, alive and stable and healthy should come first…but try to be stable when you just lost your job, have a to re-take whole semmester at school… it is not gonna work in long term.

    I feel some people push hospitization for even milder tough times (I heard people who call it a vacation…), which one could deal on their own.

  6. I would like to hear some more detailed decision criteria from a professional. Surely hospitalization is not only for suicidal patients. Depression can be debilitating far before that point.

  7. Venus, interesting comment you heard from another patient about it feeling like a vacation. When I was inpatient a woman told me ever so often she comes in “to rest.” It seemed like an odd thing to say, because for me the atmosphere was anything but restful. But, there were people who didn’t want to leave. I didn’t identify with that as I fought tooth and nail to get out. I hated every moment, it was demoralizing, depressing, and doing stupid childish crafts made me feel worse, so I guess it wasn’t a good fit. I would have been much better off had I spent that money on a trip to Hawaii.

    I guess for those who feel like it’s helpful it’s good inpatient treatment is available, but for others with depression the effect of inpatient treatment can be quite detrimental and make things worse.

  8. Wendy’s comment — “Surely hospitalization is not only for suicidal patients” — illuminates a profound flaw in our mental-health care system. In too many parts of the country, hospitalization IS only for the suicidal. The strict standard for involuntary commitment (in most states, posing imminent danger to self or others) is used to determine the propriety of even *voluntary* admissions. This approach condemns many people struggling with depression to unremitting anguish — just because, for whatever reason, they’ve determined that no amount of psychic pain will drive them to take their lives. (I’ve heard such declarations from many mothers suffering from depression: “That just isn’t an option for me. I’ve got kids.”) The narrow view that the purpose of inpatient treatment is to avert suicide illustrates our society’s inclination to overlook the grinding distress of depression until its sufferers are teetering on real or figurative windowsills. There’s nothing magical about hospitalization, of course; all sorts of custodial and residential treatment settings can bring relief to individuals weathering a depressive lapse. What’s essential is that we recognize the value of inpatient care for all serious and grueling manifestations of depression.

  9. I see my shrink once a month or 6 weeks. I tell her i think of suicide everyday i have all sorts of plans she asks are you going to do it today? I say no she lets me go. I guess when you say it everytime and you say you want die if you haven’t done it yet your not going to do it. I have been seeing her for about 3 months now. Last month i told her i had to cut myself she let me go home. We talk about nothing i say i want to die i think suicide she gives me my script for Lorazepam i go home.
    I have been admitted in the past for 2 attempts. Why doesn’t she ask me stuff she knows it is very hard for me to talk sometimes i write stuff but it’s no big deal for her. I wonder if it is because my health insurance is for indigent people through a local hospital. I also have panic attacks i had one in her office when i first saw her. I hate to leave the house. I wrote once “i was getting a hair cut and the lady was talking so much all i could think of was taking the scissors and ram it in her neck”. My antidepressants had ran out so she gave me samples and let me go home. I did write it cuz talking is to hard for me.
    At this time i am so stressed out i have applied for disability for several illnesses i live with my daughter which is highly stressful. She is paying the bills she is 40 and she bitches cuz now she has to pay i have no income i have paid her way almost her entire life yes big mistake i know that’s a whole other story.
    So when should you self go or your friends tell you to go i have no idea. My daughter says “get over it there is nothing wrong with your life”. I just say you have no idea what i am going through.

  10. I feel that hospitalization needs to be considered before getting to the suicidal point. To which, by the time that happens, one has used a lot of energy just trying to get up enough strength to survive each day.

  11. The decision for inpatient treatment is a very difficult one. My therapist once talked me into voluntarily entering into a local facility. My family freaked is a mild way of putting it until I finally just checked myself out. I wish that I had the strength to go against what they wanted and to take the time to take care of myself. When all of your strength is used just to make it through the day there is none left to fight the battles with others.

  12. When I’m talking with a client and they seem to be having a hard time just getting themselves together to carry out daily tasks, I know that they probably need more than I can do in an hour, or even two hours, a week. This is especially true if they are not sleeping or eating, talking about death, or just too emotional to perform work or household responsibilities. If they seem hopeless or have recently experienced an important personal loss, I take this into consideration, as well. Certainly, if death comes up, I want to know more about their thoughts, but I don’t automatically assume they need to be hospitalized. It does mean I need to pay attention and take some kind of action. The first action is to really listen and ask questions to get more of an idea of what their thoughts are (previous attempts, clear intent, plan, means, making preparations, justifying suicide, etc). I want to know if they really want to die or if they just want anything that will make them feel different. I want to know what or who matters to them or reasons they have for wanting to stay alive/keep trying.

    I rarely have clients hospitalized. When I do, its generally voluntary and it is for clear overwhelming suicidal thinking. What I am more likely to do with a client who is having severe symptoms and significant problems functioning is suggest that they participate in the intensive day programs that take place at several local hospitals. Some call them intensive outpatient or partial hospitalization programs. They are outpatient and usually take place from 9:00 am to 3:00 pm. These programs involve individual and group counseling and support sessions, skills training in emotion regulation, consulting with psychiatrists, and family education/counseling. I would much rather someone do this than have to stay overnight in the hospital, particularly when they have a family at home. This is much less frightening to clients than the idea of inpatient hospitalization. Plus, it is easier to get someone into one of these programs than it is to try getting them admitted into the psychiatric unit of a hospital.

    Some participants are suicidal to an extent, but not so much that they are judged to be in need of hospitalization to protect themselves from immediate harm. They may have to safety contract, as in identify several people they would tell if they thought they would act on their thoughts, several distraction techniques they could engage in when having thoughts, and procedures for getting help such as counseling center’s crisis number or calling 911 or going to the ER if necessary. Plans may need to be made to make loved ones aware of the situation so they can be alert for any signs of worsening symptoms. If the treatment team at a partial program feels a person needs to be hospitalized for safety or stabilization reasons, they can get that done much easier because that person is already under their care. The psychiatrist supervising them would make this happen.

    I tell clients this is a way to help them to stabilize more quickly and is a good way to provide them with a lot of support and skills to help them regain their balance more quickly. Honestly, it is also a quicker way to get them to see a psychiatrist for medication evaluation if they haven’t done that yet. Oftentimes, clients just don’t have time to wait weeks to see a doctor and then weeks for meds to start working. I would encourage anyone struggling a lot to consider a partial program. My clients report positive experiences with them.
    Carmella Broome, EDS LPC LMFT/I
    Author of “Carmella’s Quest: Taking On College Sight Unseen” (Red Letter Press 2009)

  13. Carmella,
    I’ve been in partial programs in the past and they have been really great for me. I get the support I need but get to go home at night. The only problem with going into partial instead of the hospital has been that the programs give people coming out of the hospital priority over people who haven’t been hospitalized. So I’ve had to wait sometimes till there is an opening. It’s actually been easier for me to go inpatient, every time I’ve gone they admit me. I go for treatment at a hospital clinc and my therapist also believes that partial is a better option for me. I’m lucky I have a really great therapist who’s helped me a lot and doesn’t send me off to the hospital every time I start thinking about dying.
    darkestangel,
    if I were you I’d be looking for a new shrink if mine was behaving the way yours is,if that is an option for you, but that’s just my opinion. I think a partial program is a great way to get the help we need without going inpatient. I’ve been in some very good hospitals and some pretty bad ones and also have to say that it does make a big differance where you go. It’s too bad that choosing where you want to go is not always an option. for me it’s where ever in the health care system that my ins will pay for has a bed available.

  14. Its fair enough to say that one needs the help and support of family and friends, and how to help one that suffers with depression. But what does one do when even thou your partner and friends or family don’t give you that support and believe it will just blow over? That what you are going through is nothing but laziness or self pity? Because you can’t handle the day today requirements. How do you get someone, Especially your partner to understand that depression is not child’s play and not a means of getting out of life’s everyday requirements. Without having to physically harm yourself first?

  15. Facts from my chair: Hospitalization is a tough decision..to leave home and family is sad in itself. It is hard work done there but it is also a place to rest from stressors. In the end it can be a triumph to have lived through it and hopefully acquired at least one new tool for survivial. I would not be here if not for hospitalization, more than once over.

  16. I have 4 kids and I have been very depressed for sometime. I have a supportive husband. I feel like I can’t handle day to day pressure. I want to disappear. I feel like I am no good for my family and they would be better off without me. I want to go in for hospitalization to maybe learn some new tools on how to survive. How do I admit myself? What are your thoughts ? I did attempt suicide many years ago and I am afraid. Please share your thoughts.

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