When depression requires hospitalization

When should people with depression be hospitalized?

Often, someone with depression can effectively manage their symptoms with the help of professional treatment, such as medication and therapy, while continuing to live at home. However, there are times when this approach is not enough to keep the individual safe, and they may require hospitalization.

Suicide risk

If someone with depression is at a high risk of suicide, it might be necessary for them to be admitted to hospital to ensure their safety ^[1]. While it is not always clear if someone is considering suicide, there are certain warning signs or risk behaviors that might indicate that someone is at an increased risk, such as ^[2][3]:

• Talking about wanting to end their life
• Saying they feel hopeless about the future and have no reason to continue living
• Making plans for a suicide attempt or obtaining items needed for the attempt, such as weapons or excessive amounts of medications or substances
• Giving away their belongings
• Becoming very withdrawn and spending a lot of time alone
• Showing extreme changes in their mood, such as becoming very angry or anxious
• Engaging in dangerous or reckless behavior with no regard for their safety, such as driving over the speed limit, using illicit drugs, or excessive alcohol use

Sometimes, someone who has decided to end their life might suddenly appear much brighter and happier, thereby causing their friends and family to think that their mental health has improved. If someone has been depressed and suddenly shows a dramatic improvement in their mood, this may also be a warning sign that they are considering suicide ^[4].

Criteria requiring hospitalization

Along with a high risk of suicide, other reasons that someone might require hospitalization to treat depression can include ^[5][6]:

• Being a risk of harming themselves or others: this might mean that they are considering intentionally harming themselves or someone else, or that their depression symptoms are so severe that they are likely to unintentionally cause serious harm to themselves or others.
• Being unable to manage their health at home: reasons for this might include not having access or means to receive appropriate treatment, an adolescent or vulnerable adult who has no support system to help them manage their wellbeing, or experiencing symptoms that severely impair self-care, leading to a lack of eating, sleeping, or maintaining hygiene.
• New or worsening symptoms: including a severe worsening of mood, or emerging symptoms of psychosis, mania, or catatonia.

In these cases, it may be necessary to receive treatment in a hospital to stabilize the individual’s mental and physical wellbeing and ensure their safety.

Usually, an individual can decide to voluntarily enter hospital for treatment if they are aware of their worsening wellbeing and wish to seek inpatient care ^[5][7].

However, if they lack insight or are not able to make the decision to receive inpatient care, it may be necessary for someone else, such as a family member, friend, or professional, to request that the individual be admitted to hospital involuntarily, in their best interest ^[1][8].

The laws around involuntary admission may vary depending on the area in which you live, so you may wish to discuss this with a professional or research how these laws are applied in your area ^[8].

What does inpatient treatment for depression involve?

Inpatient treatment for depression will initially involve an assessment of your mental state, followed by the implementation of treatment. You will have access to a multidisciplinary team of professionals, which will likely include a psychiatrist, psychologist, medical physician, nurses, and specialized therapists, such as an occupational therapist ^[1][5].

Generally, inpatient treatment for depression will last between 2-10 days, but it may be necessary for you to stay longer if additional treatment or monitoring is required ^[1][9].

While in hospital, you will likely receive ^{[5][9][10][11]}:

Medication

You may be prescribed a new medication that can help with managing acute symptoms of depression, such as an antidepressant. If you were previously prescribed a medication, this may be stopped or altered if it was ineffective. Your doctor will ensure you are prescribed a medication that works for you and that it is being taken appropriately and as prescribed.

Physical health monitoring

Your physical health will be closely monitored while in hospital, to ensure that you do not experience side effects or unwanted responses to medication, and to treat any physical health concerns that may have occurred prior to admission.

Monitoring of mental state and safety

A team of professionals will monitor your wellbeing, noting any changes in your mental state and ensuring your safety, especially if you are at a high risk of suicide or self-harm. If this risk is particularly high, you may be placed under constant observation until your mental health has stabilized, to guarantee your safety.

Therapy

You will likely receive various types of therapy, which may include:

• Cognitive behavioral therapy (CBT) or other psychotherapy, in which you can discuss and learn to manage your emotional distress.
• Occupational therapy, which can help you to learn skills to improve your functioning, or aid in improving your education or employment opportunities.
• Group therapy, in which you can receive support and advice from others, while sharing experiences.
• Family therapy, in which your family members can receive guidance to help improve communication and problem-solving, better understand your psychiatric condition and symptoms, and how to support you in your recovery.

Structure and respite

While in hospital, you will likely be expected to follow a schedule, including set mealtimes, therapy sessions, medication times, and meetings with professionals, which can help to provide structure into your daily life.

With this structure, you will be able to receive a break from usual life stressors, such as cooking, cleaning, and remembering medication, which will all be managed by other people. This will allow you to focus solely on your mental health and engaging in the things that you need for your recovery, such as resting, self-care, and therapeutic activities.

Discharge planning

Before you are discharged from hospital, your team will make a discharge plan with you, which will likely include:

• A crisis plan, with all the necessary information for you to know who to contact and how to manage, should you experience a relapse or worsening of your symptoms.
• An ongoing treatment plan, such as medications that you will be taking and how to receive your prescriptions, as well as appointments with professionals for ongoing therapy and monitoring of your wellbeing.
• Any necessary lifestyle changes, which may be advice on how to improve self-care or diet and exercise, how to reduce or stop alcohol and substance abuse, or information about practical requirements such as housing or finance support.

How to admit yourself to hospital

If you are worried about your mental health and feel that you would benefit from treatment in a hospital, you can speak to your doctor or a mental health professional about your concerns. They will likely be able to help admit you to hospital, if they agree that it is appropriate or necessary for your wellbeing ^[1][5].

However, it may not always be possible to receive care in hospital, such as if there are no spaces available, if you cannot afford inpatient treatment, or if a professional considers it would be unnecessary or detrimental to your wellbeing, so you may need to discuss alternative options to manage your symptoms and ensure that you will be safe and can access necessary treatment ^[5][9].

If you admit yourself to hospital voluntarily, this also allows you the opportunity to request voluntary discharge. Upon requesting to leave hospital, you will likely be reviewed and assessed by a team of professionals to determine if it safe for you to do so ^[7].

If it is decided that it is not safe or appropriate for you to be discharged at that time, your doctor can decide to keep you in hospital until your mental state is stabilized, thus making you an involuntary inpatient. Again, these laws may vary depending on the area, so it is important to be aware of these processes by requesting further information from professionals in your area ^[5][8][9].

If you are in a mental health crisis, you can call or text 988 from any phone to be linked to immediate support. You can also present to your local emergency department for evaluation.