Today’s psychiatric hospitals are quite different from the old asylums. The new goal: effective treatment with a short-term stay.
Far from the asylums of the early 20th century, today’s psychiatric hospitals emphasize a short-term stay with highly advanced treatment options. Once clients have been stabilized and treated, they typically go home within a few days or weeks.
A modern psychiatric hospital is the highest level of care for people with severe mental health symptoms. People who enter a psychiatric hospital may do so because they need help to:
- avoid harming themselves or another person
- monitor their behaviors during an acute episode and to stay safe
- receive an accurate diagnosis and treatment plan
- adjust or stabilize their medications
There are several types of psychiatric hospitals that offer 24-hour care:
- Psychiatric units within general hospitals (public or private). These separate units must have a specifically designated staff and space for treating people with mental health symptoms. The units may be within the hospital itself or in a separate building owned by the hospital.
- State-licensed private psychiatric hospitals. Along with 24-hour care, some of these hospitals may also offer outpatient services or partial hospitalization.
- State/public psychiatric hospitals. These hospitals provide short-term and long-term care to people who are unable to pay, for individuals requiring long-term care, and for forensic patients.
- Residential treatment centers (RTCs). These facilities are not licensed psychiatric hospitals, but the residents are still provided with mental health care. These include facilities for substance use disorders and behavioral concerns. RTCs for children must have a clinical program directed by a psychiatrist, psychologist, social worker, or psychiatric nurse who has a master’s or doctoral degree.
A 2018 study found that of 129,115 clients who received mental health care in inpatient settings:
- 39% were in private psychiatric hospitals
- 31% were in general hospitals
- 26% were in public psychiatric hospitals
People may choose to check themselves into a psychiatric hospital, or they may be hospitalized involuntarily by a family member or a physician, or after an encounter with a first responder, such as a police officer or a paramedic.
Some facilities also offer partial hospitalization. These programs provide 3 or more hours of care, but clients do not stay overnight. For some people, partial hospitalization can act as an intermediate step between inpatient care and community care.
Modern psychiatric hospitals provide acute treatment to people with severe mental health symptoms, but the goal is often a short-term stay — usually only a few days or weeks until the person is stabilized.
This wasn’t always the case.
In the early 20th century, many people with severe mental health symptoms were placed indefinitely in large institutions known as asylums. These were often crowded and underfunded, and treatments at that time were essentially ineffective or even inhumane. Once a person entered these places, it was often very hard to get out.
By the early 1950s, the first antipsychotic medication, chlorpromazine, was introduced. It was soon followed by several more. These new antipsychotic drugs helped manage symptoms of psychosis, which allowed many people with severe mental health symptoms to live within their communities.
Within the next decade, a new system of mental health care — the community mental health system — slowly began to take the place of the old asylums. This model of care continued, and most mental health care is now provided by psychiatrists and therapists in outpatient clinics throughout the community.
Psychiatric hospitals still serve an important role and treat people with the most severe symptoms, but these institutions primarily play a short-term role in mental health care.
Each person’s experience in a psychiatric hospital will be different.
For some clients — especially for individuals who voluntarily admit themselves in — staying in the hospital may feel like a break from the extreme stressors of day-to-day life.
For others — particularly people who’ve been brought in during an acute episode, such as psychosis, mania, or major depression — the situation can feel quite frightening. But the staff will try their best to help alleviate the person’s fears and make them feel safe.
Many people experiencing an acute episode are taken to their local hospital’s emergency department, where they will be evaluated by a mental health professional. They may then be placed in a safe room where they’re monitored by a staff member until they’re given a placement, either in that hospital if it has a psychiatric ward or in another facility.
At first glance, a psychiatric hospital may seem relatively sterile in appearance, since decorations like plants or wall art may be considered a safety risk. On a more positive note, however, the facility is usually kept very clean.
Clients may be given their own rooms or share one with another person. Doors are often locked and clients are monitored frequently. Clothing is comfortable — this may involve scrubs or casual shirts and pants. Belts, shoestrings, hoodie strings, and similar items are not allowed.
Depending on the client’s length of stay, they will meet with a psychiatrist at regular intervals to discuss their treatment plan, as well as several multidisciplinary team members throughout their stay that may include mental health counselors, social workers, nurses, nurse practitioners, certified nurse assistants, and chaplains.
How long is the typical stay?
All psychiatric hospitals emphasize short-term stays. For example, in one 2019 research review, the average length of a hospital stay for a person with major depressive disorder was 6 days. Though, some people with severe symptoms may stay for long periods. For example, in this review, rehospitalization often occurred within 30 days of discharge.
Clients who voluntarily check themselves in may petition to leave within a day or two, even against medical advice. If the client came in involuntary, they will undergo an evaluation process to determine whether they’re able to care for themselves outside of 24-hour care.
Every facility has different policies and procedures, but discharge typically depends on a few factors:
- medication compliance
- lack of condition-specific symptoms
These factors weigh-in on how soon a client is discharged. The doctors and staff want to make sure each person is safe and not a danger to oneself or others before they leave.
If you’re currently experiencing a mental health crisis, please don’t hesitate to reach out to a mental health professional today.
If you feel that a psychiatric hospital is the best option for you right now, try to remember there’s no shame in asking for help and you’re not alone. About 2.2 million people in the United States received inpatient services in 2020.
The doctors and staff in these facilities are trained to deliver the most advanced treatments possible to help you feel better and stay safe.