Sometimes, hospitalization for mental illness happens involuntarily and isn’t under our control. Other times, though, an inpatient stay is something we have to ponder and weigh the pros and cons of. So, what are some of the factors to consider in making that decision? This post will look at a few of them.
There are a few things to think about when it comes to suicidality. Do you have a specific plan? Do you have the means to follow through on that plan? Are you experiencing a high level of intent to act on the suicidal thoughts? Is it coming in intense, impulsive urges?
For me, I know that passive suicidal ideation (as in I’d rather be dead, but not thinking about doing anything in particular to make that happen) is something I can handle, and hospital isn’t something I need to contemplate. I also know from past experience that I’m not impulsive with suicidality, so based on knowing my own history, active suicidal ideation is something I know I can manage at home in the short term. It’s when I start looking up details of methods that I know something needs to change, whether that involves hospital or something else.
If you don’t have much appetite and just can’t be bothered with the whole eating or grocery shopping nonsense, that’s a big ol’ red flag. It’s one thing to let the higher-level self-care lapse from time to time, but it’s probably not a good idea to let the bare minimum basics slide for too long.
I don’t consider showering to be one of the bare minimum basics; however, when it gets up to about a week between showers and I’m only dragging myself into the shower because my hair is so crusty that it hurts if it moves, that’s a sign that some sort of change/intervention is called for.
Access to treatment options
Certain treatment options are easier to access when you’re in hospital. Electroconvulsive therapy (ECT) is a whole lot easier to do as an inpatient than as an outpatient. If you need a major overhaul of your meds, that may be easier to do as an inpatient, depending on how complicated your medication regimen is. Certain medication starts, such as the antipsychotic clozapine, may be easier to do in hospital because of the level of monitoring required.
Negative past experiences can be a very strong deterrent to treatment-seeking. That’s certainly been the case for me. The potential to be committed under the Mental Health ACT as an involuntary patient definitely doesn’t help matters.
For my most recent hospitalization, I tried to negotiate a voluntary admission, but things quickly went south and I got committed and put in restraints. It certainly makes for a very strong reason not to ever bring myself to hospital ever again. The mouse infestation didn’t help either.
What’s in your chart
Past experiences will affect how you feel about the prospect of hospitalization, but what’s in your medical records (whether it’s accurate or not) also influences how treatment providers will respond when you show up. Some people may get slapped with labels like attention-seeking, which can make it much more likely that they’ll get dismissed the next time they show up to hospital.
For others with a history of suicide attempts that the clinicians documenting them considered to be serious, health professionals may be more inclined to overestimate the level of risk. In my case, I have a history of multiple suicide attempts and a couple of 2-month-long hospitalizations with a whole schwack of ECTs. With the history in my chart, I can be fairly sure that if things are bad enough that I feel the need to bring myself into hospital, the question isn’t will I be admitted, but rather will I be able to talk them into admitting me voluntarily rather than involuntarily.
Diagnosis can also make a difference; certain diagnoses (like borderline personality disorder) are likely to get a cooler reception than others (like schizophrenia).
At-home crisis team availability
Some places have mobile crisis teams that are able to see people at home to give them extra support and keep them out of hospital. (I used to work for one such team.) I don’t think I’d ever want that for myself, partly because I don’t want people invading my space, but mostly because I don’t typically find talking to people all that helpful. If things are really bad, I want ECT, and the talking part is mostly just the price I have to pay to get the ECT.
Community crisis home availability
This kind of thing may or may not exist where you are, but some communities have crisis facilities in a home-like setting with round-the-clock nursing staff. It can be a less intense, more comfortable kind of setting than hospital.
Anytime you’re faced with this choice, I encourage you to do what seems likely to be most helpful, even if it feels selfish. Don’t try to pick the option that works best or is easiest for other people in your life; go with what’s best for you.
Is this something you’ve ever needed to contemplate? What were some of the factors that you weighed in making your decision to seek or avoid inpatient care?
The post Cell Phones on Psych Wards—Yea or Nay? is the hub for all psychiatric hospitalization-related content on Mental Health @ Home.
The So You’ve Just Been Diagnosed with… [a Mental Disorder] page brings together information, advice, and resources from people who’ve been there. New input is always welcome!