Can I get thrown into a psych ward? Understanding mental health treatment. Part 1: Inpatient hospitalization/Crisis Residential

Sometimes people get anxious knowing that somehow they can get put into a psych hospital. Rest assured, it is not that simple or easy! It is a necessary “evil” when the situation is deemed appropriate which is why we will be talking about treatment levels. It can get pretty confusing when you hear that there are so many kinds of mental health therapies out. 

For this blog series, I want to share my thoughts about treatment from a standpoint of severity and intensity of treatment. Treatment can be understood from a spectrum from most intense to least intense. In the next several blog posts, I will go ahead and break down the different kinds of therapy from that order, explain what you can expect, and what kind of circumstances these treatments are most suitable.

Inpatient hospitalization: This kind of facility is the most intense form of treatment in the psychiatric world. Unfortunately movies like Changeling, Sucker Punch, and Girl, Interrupted have painted a horrific kind of picture for inpatient units. Usually we think of padded rooms, crazy asylums, screaming people, prison-like environment, mean nurses, and over medication. While this may be true in the past (definitely the dark chapters of early psychology), this has largely changed for the better. The key function of inpatient treatment is stabilization. That means keeping the individual safe from him or herself as well as other people. The only way people get referred to this level of treatment is when someone is actively trying to hurt themselves (e.g., suicide attempts, self-harm), hurt someone else (e.g., homicidal tendencies with an identified target), or gravely disabled (one cannot take care of their daily needs) for the reason of mental health challenges. I want to emphasize that it has to be because of mental health challenges. That means that if someone was out to hurt someone but it was not due to mental health reasons, then law-enforcement like the police and prison would be involved but not hospitalization.

I want to emphasize that inpatient hospitalization is a really big deal because it is one of the few interventions where a citizen is forcibly removed of their personal freedoms. As a clinician, we treat hospitalization very seriously and know that this could have potential traumatic effects. I have to seriously weigh out the benefits and costs before making this decision. In the state of California, the term 5150 hold (or 5585 for minors under 18-years-old) refers to the section number of the Welfare and Institutions code that is written in order to put someone in the hospital. That means that the individual is deemed the safest and it is medically necessary to place him in inpatient treatment. Usually there is up to a 72 hour time frame to stabilize and assess the needs of the individual before making the next move in treatment. In terms of inpatient treatment, it usually consists of groups to learn coping skills and to understand the nature of the problem. If necessary, a psychiatrist may prescribe certain medications to help with that stabilization process. If it is a child or teen, usually a family session and parental involvement will occur.

Crisis residential is similar to inpatient hospitalization in that the individual gets to stay in the hospital for further stabilization (usually up to 2 weeks). Sometimes there is just too much going on at the home environment that it would be more beneficial if the individual gets a mental and emotional respite or break. The individual and/or family members get a chance to talk about treatment goals and how to continue supporting the individual moving forward during the meetings.

Bottom line: Inpatient hospitalization is deemed necessary only when someone is a danger to self, others, and/or gravely disabled due to a mental health challenge. The sole purpose of this level of treatment is stabilization and understanding the nature of the problem. No one can just “throw you in the hospital” unless these specific conditions are met. If you are ever worried about a loved one for their own safety or the safety of other people... an inpatient visit is the safest place that person can be. It is often very difficult to witness but remember that it is the loving thing to do. For more entries like this, please visit me on my blog.