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.
Suicidality
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.
Basic self-care
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.
Past experiences
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.
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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!
I’ve had three multi-month admissions, one that was a couple of weeks, and two weekend holds. Only the weekend holds were involuntary, but since they were post suicide-attempt, I didn’t consider them a bad idea.
I tend to wait too long to seek inpatient care and this is mostly because of concern for what it might mean for other people. I’m glad you included the reminder that seeking help isn’t selfish.
I lol’d the hair comment. I also rationalize really bad/unclean hair in creative ways (I’m all about being green 🙄) that skirt my truth.
Lately I’ve been rationalizing not eating much as being actually good for me because I’m losing some excess medication-related weight. If only it were easier to channel that rationalization creativity into more constructive things…
Right? Why am I only a mastermind of the criminal variety?
Lol
Sometimes I think a good ole inpatient stay would be like a welcomed fucking vacation from life. I went inpatient after I tried to kill myself when I was 17x and it was one of the better months of my life.
I know the entire mental health system is more or less fucked, so that scares me a lot. But the idea of intensive therapy, not having to take care of anyone else and just focusing on myself and my health for once…I wouldn’t hate it. I would fight it every step of the way and beg and plead not to go, but I wouldn’t hate it.
I’ve heard other people talk about that vacation from life element, but I’ve never had that personally. I think it’s probably because my first hospitalization felt so horrible, and that set the tone for hospital being associated with bad things in my mind.
I could definitely see that. My first experience was relatively good, and I didn’t want to leave. I didn’t exactly have a good thing to go back to though either.
It does scare me a lot though, and I know so much can go wrong and be misinterpreted. “Help” can very quickly turn unhelpful.
That’s for sure.
No, and I’m afraid of therapists for that reason. My girls have wanted me to talk to someone for years about anger and depression, but I can’t. I feel I won’t be truthful about my occasional desire to just be fucking done with all this, so what is the point if I’ll be dishonest? I know I won’t do anything suicidal bc of my girls, so I’m never worried about it…
I wish there was a way to be honest without people getting themselves overly worked up about what that honesty could mean. Self-censoring isn’t good, but it feels so necessary.
As someone who’s been hospitalized more times than I can count, I can say there is a certain level of “out-of-controlness” that is occurring when I end up going. I am feeling like I may do something impulsively, even if I don’t have a big plan.
It’s good that you’re able to recognize when that’s happening.
Our big signs for suicidality have been withdrawing from everyone—therapists and family—and making suicide plans
We shower these days only when itching becomes intolerable; it’s usually 4 days or so.
Food is a big indicator for us, too. But eating in hospital is one of the biggest deterrents for us: we have so many sensitivities and the hospital struggles to meet our food needs. The other deterrent is lack of personal space. We cannot poop under these 24 surveillance conditions. We need space to toilet and can’t get it in-patient. The flip side is gaining community: we feel like the trauma patients at these hospitals are our tribe.
If there was a nonviolent communication hospital, we’d probably go. But we just don’t know how much more DBT and positive affirmations can do for us.
We really appreciate residential program with more space and freedom (they let us use our binoculars to look at birds!!), but the time commitment is daunting. We don’t want to have to stay for x weeks. We want to leave when we’re safe to leave, even if we haven’t completed five weeks or whatever.
I can definitely seeing food and lack of personal space being issues. A combination of freedom and flexibility would be nice.
I’ve experienced times when I thought I was better off dead or wished I was dead, but I’ve only actually googled ways to kill myself one time. I knew I needed to tell someone so I did and then was involuntarily committed. Hopefully I don’t go through that again. I really feel for the people that go through that. The only thing I can think of that I really need to be careful about is mania. I don’t know if I’ll ever have another psychosis because I will never stop my medication (that’s the only time I’ve had them in the past after my first one), but I hope I can catch the warning signs and check myself into a hospital to avoid any risky behavior. My parents check on me a lot so I try to listen to them now. I have too much to lose now.
That’s good to have that external source of feedback to help catch if things are off.
This IS something I’ve contemplated—going inpatient. Bad suicidal thoughts and horrific symptoms have had me speaking with medical personnel a number of times. It seems though, that they usually only want me when I’m off my meds (which is never). Some of my encounters with hospital personnel happened when I was trying different dosages of meds (but still taking meds). So, that is something worth noting.
It seems kind of strange that you being on meds would be their deciding factor. It seems like symptom severity should be the key thing.
I wish I knew 100% that that wasn’t just my takeaway, rather than the true situation. I guess it may have been a factor, or then again, maybe not.
I’ve faced one major incident of being pressured to voluntarily admit myself, that was late last year, and I couldn’t make up my mind despite on being on a 24/7 watch by friends for a few days (and you know what happened next), including one sleeping outside my bedroom door… simply because there weren’t crisis options and I couldn’t afford a non-emergency ambulance or psych ER fees, plus my clinicians knew inpatient would be traumatic for me. Being watched by friends wastge next best option but should never have been allowed to happen.
My psychologist got really worried as she never needed to worry like that (is that good or bad lol???) about me since the start of our therapy.
I know my warning signs now, and I’ll admit myself voluntarily if I need to.
It’s really unfortunate that there are so many barriers in place to getting appropriate care.
Definitely. This time though, I doubt I’d become so dangerously suicidal again, simply because it’s better to be depressed and very lonely offline (Love my 2 loyal offline ones who witnessed the entire shit show, amd my friends here on WP) VS depressed and having folks I thought of as friends *majorly betray* me. ❤️❤️❤️
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Good post Ashley…
Yes there are definitely stages of the whole suicidality element… I think I’ve been through them all.
I am back but have changed my blog a bit… so it just has all my poems now as I wanted to keep that part of it.
Nice to see you back. ❤️❤️❤️
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This is really good and important for people to read! A voluntary can he do empowering…it’s an ultimate display of self-care and responsibility.
That’s a good way of putting it.
Thanks!
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?
I have thought about voluntary committal a few times this year alone. I was involuntarily committed in 2011 for a month and while it helped my severe bout of depression at that time, it frightened me. I was terrified the whole time I was there and I realize it’s because of the stigma attached to being committed to a mental hospital. I was also almost placed under a 72 hour hold because I said, quite honestly, that I was depressed most days. A very green doctor took that to mean I was suicidal and must need committal. The cops were called when I tried to leave that physical exam and they escorted me to a ‘safe’ room in the local hospital and their on-call therapist/psych was called in. We talked, he ‘got’ my meaning and I was released *whew* The stigma part might be why I don’t go get things adjusted too. They’re not bad, I have a therapist I meet with weekly and a good psych.
Your own story is so much more stressful and supports fears about the stigma of the mental hospital. I’m sorry you had to undergo it, even if you chose to do that. They didn’t listen to you and that’s horrifying!
I wish that doctors would recognize that overreacting to things can make for a traumatizing experience for the patient involved. Calling the police should be very low on the list of options to consider most of the time.
I appreciate this balanced perspective.
I hadn’t heard of the mobile crisis teams. That sounds like something I might want.
I’ve had low appetite and had a hard time bringing myself to eat for several months now. To me that’s not a sign that I need to go to the hospital. But perhaps I should take it more seriously than I have been. I just don’t know what’s causing it so I don’t know what to do about it. My therapist and my nutritionist are both kinda lost on how to help me at this point.
I hope you’re able to figure out what’s going on.
Thanks
Thanks for taking interest in what I write. I’m glad I’m not alone and can express myself without judgement.
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