National Alliance on Mental Illness
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When is the hospital the right place for care?
Psychiatric hospitals are designed to be safe settings for intensive mental health treatment including observation, diagnosis, individual and group psychotherapy and medication management. Inpatient treatment should be part of an overall plan of care, a coordinated effort between the individual, the family or other supporters, the inpatient treatment team and outpatient service providers.
Because inpatient care interrupts daily life and is expensive, hospitalization should be reserved for situations when round-the-clock safety, observation and care are required. Most hospital stays are only long enough to resolve the most urgent issues, from a few days to a few weeks. Alternatives can relieve the need for full hospital care or serve as part of the discharge process and, depending on availability, may include short term crisis stabilization units or psychiatric emergency rooms, intensive outpatient treatment or partial hospitalization, residential treatment or housing with intensive long term services and supports.
What care can I expect while in hospital?
Intake interview: Upon arriving at the hospital you will meet with an intake clinician who will ask about your current feelings, thoughts and what has been going on with you. Your belongings will be locked in a secure place. You will be asked to complete documents about insurance coverage, past mental and physical illness, allergies, release of information to other providers. If you are 18 years old or older your family or other supporters will only be involved if you give written consent.
Consent to Release Information: A "consent" form allows you to choose which family or friends, if any, will be involved in your care. If you do not choose anyone your family and friends will not be able to get any information about your care even if they ask. You may sign a "consent" form at intake or any point in your hospital stay.
Diagnosis: Early in the hospital stay a psychiatrist or therapist will meet with you to ask about your feelings, thoughts and how life has been for you recently. The doctor will give one or more diagnoses to guide your treatment process. The diagnostic interview is used to identify which disease(s) the doctor thinks you have in order to guide treatment. Because there are no lab tests to definitely identify mental illness several tries may be necessary to get an accurate diagnosis and effective treatment. Learn more about mental illness and diagnosis.
Medication management: The psychiatrist may prescribe new medication or dosage adjustment. To clarify whether change is needed the doctor may order a "drug holiday" in which you stop taking all medications for several days while nursing staff observe your symptoms. Lab work, including blood or urine samples may be needed to determine whether changes are helpful.
Individual and/or group therapy: While in hospital you may be offered individual counseling or group therapy to explore thoughts, feelings, perceptions and/or relationships that led to the hospital admission. You will have a chance to learn new approaches to situations that triggered past crises. Learn more about types of therapy and psychosocial interventions.
Suicide watch: If you are at risk of harming or killing yourself hospital staff will be assigned to monitor you around the clock until the crisis passes. You may be placed in an observation room by yourself and checked every 15 minutes or a staff member may stay with you.
Seclusion and restraints: Some hospitals use restraints or isolation rooms to manage physical aggression or self-injury. Because seclusion and restraint are considered last resort strategies to maintain physical safety, hospitals increasingly use other methods. If seclusion or restraint is used the hospital is required, by law, to check on you at regular intervals and to release you as soon as the risk of harm has passed.
Recovery skill education: Recovery education includes learning about mental health and substance use disorders, relapse prevention, how to cope with stress and maintain wellness. Healthy choices regarding sleep, diet, exercise and relationships promote recovery and reduce the chance of crises.
Discharge planning: As the time approaches to leave the hospital a social worker or care coordinator will meet with you to plan treatment continuity in community-based services. The social worker should work with you to make appointments with a psychiatrist, therapist, case manager or other community mental health service providers and may recommend support groups or peer-run services. Arrangements should be made for safe housing, income and health care coverage.
Involving family or friends in care – Consent to Release Information
During admission to hospital, you will be offered the chance to sign a form often called Consent to Release Information, Authorization to Release Information or Information Release. By signing this form you give permission for family or others who are part of your support network to get information about your care. You do not have to sign the form if you don't want others involved. Without a signed consent form, the hospital staff must maintain complete confidentiality and will not be able to even confirm or deny that you are in the facility. Regardless of whether you sign a consent form your family and supporters can still give information to the hospital team, but hospital staff will simply listen and without responding.
You can change your mind at any time during the hospital stay if you decide that you would like your family or supporters to visit or be involved in your care. Request the Information Release form from one of the hospital staff. You have the right to select who can visit or receive information about your care, what types of information you would like shared or kept private, and when the permission will expire.
Voluntary and involuntary admission
If you and your doctor agree that inpatient treatment is a good idea you may be admitted on a voluntary basis, meaning that you choose to go. Some private hospitals will only accept voluntary patients.
If you pose an immediate safety risk to yourself or others due to symptoms of mental illness and you don't want to go to hospital, you could be committed on an involuntary basis; that is, against your will. Because involuntary commitment overrides your civil liberties strict laws and procedures are in place to protect your rights. Rules vary by state, but civil commitment must be limited initially to a few days. If the commitment order is to be renewed a judge and two doctors must agree that you still need to be in hospital. While in hospital you have a right to receive treatment in order to become eligible for discharge.
Patient rights, complaints, grievances and appeals
Rights for inpatient care vary, but usually include the right to receive humane treatment with dignity, right to refuse treatment (with limited exceptions), right to understand the risks, benefits and alternatives to a particular type of treatment, right to confidentiality, right to receive mail and make telephone calls, right to safety, sanitary conditions and well-balanced nutrition. You also have the right to advocacy and must be informed of your right to file complaints and grievances.
If you feel your rights have been violated the hospital must provide an advocate to hear your concern, resolve it if possible and help you file a complaint if you so choose. If not satisfied with the result you have the right to appeal to an independent advocate or the state department of mental health. Protection and Advocacy (P&A) agencies are independent federally funded organizations charged with investigating abuse and neglect in mental health services.
Types of psychiatric hospital
Public mental health facilities, private free standing psychiatric hospitals or psychiatric units in general hospitals are the most common types of inpatient treatment settings. Public psychiatric hospitals are operated by state or county governments. Free standing private psychiatric hospitals may be operated by non-profit organizations or for-profit corporations. Mental health units in general hospitals may be operated by government, non-profit or for-profit organizations.
Payment for hospital care
Inpatient treatment is expensive. Even a brief stay can cost thousands of dollars. You have the right to know what will be covered and what charges you will be responsible to pay. Private insurance, Medicare, Medicaid and state or county general funds may pay for psychiatric hospitalization. IMD Exclusion: Inpatient care in a free-standing psychiatric hospital (public or private) may be covered by Medicaid for children or seniors, but not for adults age 18 to 64 because federal law excludes "Institutions for Mental Disease" (IMD) from Medicaid coverage. With the goal of exploring whether the IMD exclusion should continue, a few states have been granted exceptions allowing Medicaid to pay for care in private free standing psychiatric hospitals.