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What is a psych ward?

Obtaining inpatient psychiatric treatment, preparing for admission to a psychiatric ward, the admission procedure, a day-in-the-life of a psychiatric hospital, advantages of inpatient treatment, disadvantages of inpatient treatment, finding the right place to get inpatient care, the psych ward: what is a psychiatric hospital really like.

Our views of inpatient mental health care are often shaped by disturbing portrayals in movies and TV shows. But here’s what you can really expect from a psychiatric ward or “mental hospital.”

In the United States, a psychiatric ward, psychiatric unit, or behavioral health unit is a place where people go to get help for severe mental health issues. It is in a hospital setting and provides a safe environment with 24-hour monitoring by trained staff.

Having a serious mental health issue on its own does not automatically mean you need to be in a psychiatric facility. But you may consider seeking admission if you think that you are likely to cause harm to yourself or because your mental health has affected your judgment to the point where you are putting others at risk. Specific mental health issues that may warrant inpatient psychiatric treatment if they are severe enough include:

• Bipolar disorder
• Eating disorders

Of course, the prospect of being admitted to a psychiatric unit can be a frightening one. Psych wards are often portrayed in a negative light and there can still be a great deal of stigma associated with seeking inpatient mental health care. However, while everyone’s experiences are different, by learning about what inpatient psychiatric care in the U.S. is really like, you can better decide if it’s right for you or a loved one.

Psych ward vs. psychiatric hospital

A psychiatric ward or unit is usually located in a general hospital, catering specifically for patients with psychiatric problems. A psychiatric hospital, on the other hand, is a whole hospital specializing in caring for people with mental health conditions.

A psychiatric hospital is usually split into units serving different populations. For example, it might have a unit for children, another for adolescents, a men’s unit, a women’s unit, and an LGBTQIA+ unit.

How long is a psych ward/psychiatric hospital stay?

Over the years, the average length of stay for inpatient mental health care has been getting shorter. In 2018, the average stay for adults in the U.S. lasted between five and seven days . Long-term hospital admissions that lasted weeks used to be routine decades ago but are now rare.

While some psychiatric hospitals allow people to seek admission directly, most people in need of inpatient psychiatric care go to a hospital emergency room first.

In the emergency department, you or your loved one will undergo a comprehensive evaluation that often involves an interview, lab work, and a physical. Using this information, a team of mental health providers will determine the best level of care for your needs.

Many facilities use the Level of Care Utilization System (LOCUS) to guide their assessment and determine the right level of care. The highest level of care they can assign to someone is involuntary inpatient, followed by voluntary inpatient.

Involuntary psychiatric care

If someone is at grave risk of harming themselves or someone else, then it may be necessary to admit them against their will. State laws differ, but qualified professionals usually make this determination, rather than family members. However, family members can be an important source of information.

[Read: How to Help Someone with Mental Illness Accept Treatment]

Voluntary inpatient psychiatric admission

The emergency medical team will refer you for voluntary psychiatric inpatient care if you are at risk for harm but are willing to get help. During voluntary admission to a psychiatric unit, you usually retain the right to leave, but this depends on what state, province, or country you are in.

Other levels of care

After meeting with you, the emergency mental health team might decide that an outpatient level of care might be best for you. If so, they will give you some options and make a referral.

If the emergency mental health team refers you to inpatient psychiatric treatment, they will arrange to get you to the unit. If it is in the same building, they will walk you there. If it is somewhere else, they will arrange transportation.

What to bring with you

Most of the time, you cannot go home between the emergency department and the psychiatric hospital, so arriving at the emergency department prepared for your inpatient stay is best. Here are some items to consider bringing with you.

Clothes. Many units will let you bring your clothes, but some will not. If you do bring clothes, bring about three days’ worth, and avoid the following items because they can pose a safety hazard, and the hospital might not let you keep them:

• Drawstrings

Medication. This also varies between hospitals. You should at least have a current medication list with the names and dosages of the medications you take.

If you bring items you cannot have on the unit, consider having a plan to get them picked up and brought home. Hospitals may be able to lock up your belongings and return them to you when you leave, but they do not always have that ability. Items that you might want to call ahead to find out about include:

• Electronics (tablets, computers, cell phones).
• Personal grooming supplies (makeup, lotion, shampoo).
• Medical equipment (CPAP, walker).

What not to bring with you

Items that you can easily use to harm yourself or others are unlikely to be allowed into a psychiatric unit, as are items that are counter-therapeutic. Prohibited items usually include:

• Razors, knives
• Glass bottles
• Metal objects
• Drugs or paraphernalia
• Plastic bags

Once you arrive at the unit, there is usually an admission process. This process might include the following steps:

There will be several forms to sign and complete upon admission. These may include:

• Treatment consent.
• HIPAA privacy policy.
• Patient bill of rights.
• List of people who are allowed to know about your presence in the unit.
• List of people from whom you are willing to accept phone calls.

If you have a psychiatric advance directive , this is when to let the staff know. A psychiatric advance directive is a legal document you would have filled out beforehand that communicates your treatment preferences. You can also name a healthcare proxy.

Safety search

A staff member will look through your belongings for objects that could be used to cause harm to yourself or other people, such as strings, sharp or heavy objects, and drugs or medications. Some units allow you to keep your cell phone; some do not. Anything not allowed on the unit will usually be locked somewhere and returned to you at discharge.

The safety search will usually involve a search of your body. In some hospitals, this will involve disrobing. This process is performed in a private area away from other patients.

Admission interview

Clinical staff will sit down with you and ask about what brought you to the hospital, your health history, the medications you take, and your alcohol and substance use. The interview can take from 30 minutes to over an hour, depending on the complexity of your medical history.

You may find that the inside of a psychiatric ward bears little resemblance to how movies often portray it. Most programs more closely resemble a conference or an indoor camp with added medical treatment.

The other patients’ mental illnesses are unlikely to be obvious. While other patients may share some of the challenges they are experiencing with others, their reason for being there is rarely known to anyone but the treatment team and themselves.

Medication administration

Most hospitals do not allow medications to stay with patients. Medications are usually administered in a designated area, or privately by a nurse.

Meeting with your treatment team

You will usually meet with a psychiatric team leader once a day. Other staff members, such as a nurse or social worker, may also attend the meeting or meet with you separately.

They will ask you about how your treatment is progressing, and make any needed adjustments. Patients have a right to opt out of this meeting, but it is advisable to attend because this is when decisions about your treatment are made.

Skills and education groups

Many inpatient settings hold therapy groups. These groups teach skills that can be immediately applied, such as cognitive reframing or setting boundaries with others.

A common misconception is that inpatient groups involve sharing personal problems with others. This is usually not true in inpatient settings.

Free time and recreational therapy

Units may vary widely around how much free time they schedule. Some only schedule an hour at the beginning and end of the day, while others may schedule larger chunks of time. Some units offer more structured recreation activities instead of free time, such as recreational therapy groups that teach you how to wind down in healthy ways.

Art supplies, board games, books, and puzzles are often available to patients in inpatient units. Many units have a television available, although there may be rules about what type of programming is allowed and when the television can be turned on.

Hospitals usually serve meals individually to each patient. Most states have infection control rules that prevent a family-style or buffet-style serving method. How this looks varies, but most hospitals will offer you a choice between a few options. They will also accommodate most special diets, such as vegetarian or vegan, and any diet ordered for medical reasons, such as no sodium or low FODMAP.

In some hospitals, patients may be able to go to the hospital cafeteria accompanied by staff.

It is common for there to be restrictions on the number of visitors who can come to see you at one time. These restrictions are usually for security, since hospitals must maintain a safe environment to protect patients from hurting themselves or others.

There are usually specific visiting hours. Depending on the level of security at your hospital and your own personal circumstances, staff may supervise visits to prevent any possibility of your visitor giving you prohibited items.

Patients almost always have access to laundry facilities in units where they can wear their own clothes. If it is a large unit, you may have to schedule a time to do your laundry. The facility will usually provide laundry soap, but it would be good to check ahead of time as they might make you pay for it.

You can expect to be able to shower privately from other patients, but depending on your level of precautions, staff may need to check on you or be present to maintain your safety.

Showers are usually located in a locked area and tend to be available only during scheduled free time.

Staff checks

Staff will check on you frequently throughout the day and night as part of the strategy for maintaining your safety. If you are at extremely high risk of harm, you may be assigned a staff member who will remain close by and always have eyes on you.

Seclusion and restraint

Most people who are admitted to a psychiatric unit do not experience seclusion or restraint. In 2023, for every 1000 hours of patient care delivered in the U.S., less than 1 hour was spent administering seclusion or restraint.

If it were to happen to you, it would be because you were in the act of trying to harm yourself or someone else, and other means of de-escalating the situation did not work. Situations where a restraint might be needed could be during a hallucination, a suicide or self-harm attempt, or when someone cannot control their anger and lashes out violently.

A restraint can take the form of a quick manual hold or, if a longer duration is needed, you may be placed in a specialized bed. Alternatively, some facilities may choose to keep you safe by separating you from other patients and placing you in a locked room where there is nothing available to use for self-harm. This practice is known as seclusion.

Staff watches you constantly while in seclusion, either by sitting near you, watching through a window, or via video. Both seclusion and restraint are used as a last resort and for the minimum possible time.

The inpatient unit is a safe environment. It is harder to harm yourself in an inpatient psychiatric unit. Many units are constructed in a way that makes it difficult to tie a string to anything. Objects that have the potential to be harmful are restricted from entering the unit, and there is 24-hour staff monitoring.

Social support. Loneliness and social disconnectedness are often a significant contributor to poor mental health. Even for people who are not lonely, they may benefit from being around others in similar situations. It helps you know that you’re not the only person experiencing these issues. Seeing people around you start to feel better can also give you a sense of hope.

Stability and routine. The stability and routine you encounter in a psychiatric ward may be directly helpful to recovery. Therapies that incorporate daily behavior habits, such as interpersonal social rhythm therapy, show a positive effect on illnesses such as bipolar disorder. While most units are not yet formally incorporating social rhythm therapies, adhering to a daily routine where light exposure, eating, and social activities happen consistently, can help you establish stability and routine.

In-the-moment coaching. Having someone nearby to coach you in applying your newly learned skills when you need to use them can be helpful. In an inpatient facility, staff are present around the clock and can coach you when a crisis happens. In a hospital, you can get real-time coaching in situations such as dealing with cravings, having a bad phone call, and setting boundaries .

Being limited from seeing family and friends. Many units limit the number of guests you can have and when they can visit. If your family and friends are supportive, you may find it harder to get support from them while you are an inpatient. This is especially true if the hospital is located far away from your network of friends and family.

Limited access to coping skills. Because inpatient units are such heavily controlled environments, it can be difficult to access the usual coping skills that you might use. For example, listening to music on a unit that limits electronics access may be difficult. If you are used to running to let off steam, it’s unlikely you’ll be able to leave the unit to do that.

Some people have reported feeling worse. Some people have reported that measures taken to ensure safety in the psychiatric unit aggravated their trauma and led to increased anxiety. Being restrained by staff, witnessing other patients being restrained, or seeing others cause themselves harm, argue, or fight can all have a negative impact.

The goal of inpatient treatment is to get you or your loved one to a place where you can manage without 24-hour nursing supervision in a safe environment.

Once the acute phase of the crisis has passed, the treatment team may start to consider discharging you. This does not mean that treatment is complete. Most people need to continue their treatment once they leave. You may continue in a residential substance use treatment facility, attend an intensive outpatient program while living at home, or continue with counseling and medication management appointments.

Who decides when it is time to leave the hospital?

The treatment team leader—usually a psychiatrist, a psychiatric nurse practitioner, or a physician’s assistant—will write the order to discharge you. However, other team members such as your primary nurse and social worker will also have to sign off on it.

Ideally, your discharge date will not be a surprise. Every day you meet with your treatment team, you should talk about where you are with your goals and what needs to happen before you can be discharged. Your input on this topic can be crucial in deciding the right time to leave.

What if I want to leave before my team is ready to discharge me?

If you are a voluntary patient, what happens in this situation differs from state to state. In some states, you can be prevented from leaving while your treatment team decides if you can be discharged against medical advice. This can take a couple of days, and you may have to put your request in writing.

In other states, a hospital cannot prevent you from leaving at any time, day or night, unless they determine that you are likely at risk of harming yourself or someone else upon discharge. In this situation, they would have to convert your status to involuntary if you meet the criteria.

Speak to a Licensed Therapist

BetterHelp is an online therapy service that matches you to licensed, accredited therapists who can help with depression, anxiety, relationships, and more. Take the assessment and get matched with a therapist in as little as 48 hours.

Researching ahead of time may help you decide on the right inpatient unit for you or your loved one. Here are some ways you can evaluate a potential facility.

Check for adequate staffing

Due to how hospitals are reimbursed, there can be pressure to cut nursing services to save costs. When staffing is cut too aggressively, there may be insufficient staff to prevent events that lead to seclusion and restraint.

While there is no universal standard for staffing psychiatric inpatient units, the law in California provides a good reference point. In California, psychiatric units must have a minimum nurse-to-patient ratio of one to six. Some states collect and publish information about hospital staffing ratios. You can also find out how a unit is staffed by calling the unit and asking.

Check the rates of seclusion and restraint

Restraint and seclusion can happen in psychiatric settings when a patient is attempting to harm themselves or someone else. When this occurs, it can often be traumatizing to the person involved as well as those who witness it. For this reason, an environment where there is less of this practice is usually more therapeutic. Depending on where you live, you may be able to look up the rates of restraint and seclusion in your local hospital. Lower than average is better.

In the U.S., the Centers for Medicare and Medicaid (CMS) collects data on seclusion and restraint in hospitals and makes it available to the public.

Evaluate how you are treated when you call

The culture of a unit can be difficult to judge from statistics and printed material, so another thing you can try is to call the unit directly and ask questions about what you can expect.

• How are you treated when you speak with someone on the unit?
• Were you treated with respect?

How staff treat you when you call can give clues about how you or your loved one would be treated as a patient. You can also look for reviews about a facility from former patients, as well as the admitting hospital emergency department.

Suicide crisis lines in the U.S.:

988 Suicide and Crisis Lifeline at 988 or IMAlive at 1-800-784-2433.

The Trevor Project offers suicide prevention services for LGBTQ youth at 1-866-488-7386.

SAMHSA’s National Helpline offers referrals for substance abuse and mental health treatment at 1-800-662-4357.

Suicide crisis lines worldwide:

In the UK and Ireland : Call Samaritans UK at 116 123.

In Australia : Call Lifeline Australia at 13 11 14.

In Canada : Call Crisis Services Canada at 1-833-456-4566.

In other countries : Find a helpline near you at Befrienders Worldwide , IASP , or International Suicide Hotlines .

More Information

• Medicare Hospital Compare - Check the rates of seclusion and restraint at your local hospital, along with other quality measures.
• The National Resource Center on Psychiatric Advance Directives - Establishing psychiatric advance directives.
• The LOCUS website - Information about how professionals determine the right level of care. Scroll down to find information for patients and families.
• Adepoju, O. E., Kim, L. H., & Starks, S. M. (2022). Hospital Length of Stay in Patients with and without Serious and Persistent Mental Illness: Evidence of Racial and Ethnic Differences. Healthcare , 10 (6), Article 6. Link
• Hennessy, B., Hunter, A., & Grealish, A. (2023). A qualitative synthesis of patients’ experiences of re‐traumatization in acute mental health inpatient settings. Journal of Psychiatric & Mental Health Nursing (John Wiley & Sons, Inc.) , 30 (3), 398–434. CINAHL. Link
• Steardo, L., Luciano, M., Sampogna, G., Zinno, F., Saviano, P., Staltari, F., Segura Garcia, C., De Fazio, P., & Fiorillo, A. (2020). Efficacy of the interpersonal and social rhythm therapy (IPSRT) in patients with bipolar disorder: Results from a real-world, controlled trial. Annals of General Psychiatry , 19 (1), 15. Link
• Wickramaratne, P. J., Yangchen, T., Lepow, L., Patra, B. G., Glicksburg, B., Talati, A., Adekkanattu, P., Ryu, E., Biernacka, J. M., Charney, A., Mann, J. J., Pathak, J., Olfson, M., & Weissman, M. M. (2022). Social connectedness as a determinant of mental health: A scoping review. PLOS ONE , 17 (10), e0275004. Link
• Sowers, Wesley, Charles George, and Kenneth Thompson. “Level of Care Utilization System for Psychiatric and Addiction Services (LOCUS): A Preliminary Assessment of Reliability and Validity.” Community Mental Health Journal 35, no. 6 (December 1, 1999): 545–63. Link
• “NRC PAD | National Resource Center on Psychiatric Advance Directives.” Accessed April 22, 2024. Link
• American Association for Community Psychiatry. “LOCUS.” Accessed April 22, 2024. Link
• “Find Healthcare Providers: Compare Care Near You | Medicare.” Accessed April 22, 2024. Link
• “Inpatient Psychiatric Facility Quality Measure Data – by State | Provider Data Catalog.” Accessed April 22, 2024. Link

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Mental Health

The dos and don’ts of visiting someone in a psychiatric hospital.

I’m writing while I’m recovering from a manic episode. This means I’m no longer psychotic or severely manic. I’m still in hospital because we’re in the process of changing back to my old medication regime, my sleep cycle needs work and there’s the risk of “manic misadventure.” We’re “fine-tuning” everything so I have a successful and long recovery/remission out in the community.

During my past hospitalizations, I’ve identified some “do’s” and “don’ts” when it comes to visiting (or not visiting) loved ones in hospital, and I’ve put them together in a rough guide. As everyone is different, I would like to point out this is how I like to be treated, and it’s always important to gauge the patient’s individual situation when visiting them.

Don’ts: 

1. Don’t show up unannounced. Like with physical illnesses it can be tiring having visitors. Particularly if you’re depressed and just need time to yourself.

2. Don’t make yourself scarce. Don’t be afraid to message or ring the patient if you can’t get to the hospital. Send cards or flowers to let them know you’re thinking of them.

Psychiatric hospitals can be intimating and visiting someone in a psychiatric hospital can be confronting, but this is not an excuse not to visit (besides psychiatric hospital aren’t scary, they’re just normal hospitals with normal patients). During my first manic episode, two of my good friends hardly visited for two months, which really hurt. The hospital can be lonely and boring, so getting visitors is always the highlight of the day. (I would like to point out that those two friends have been fabulous during this manic episode.)

3.  Don’t pity the patient. I don’t want pity. I want empathy and at times I want sympathy, but I don’t want anyone to pity me. Pity can feed the ruminating spiral of depressive negativity and puts a wet blanket on resilience. Yes, having bipolar can be difficult at times, but it is manageable and I normally live a rich and fulfilling life. So please, no pity parties.

4. Don’t act like the patient is a different person or what they have is contagious. This is very insulting.

5. Don’t blame the person for being in hospital. No one wants to be so unwell they have to be in hospital. It’s no one’s fault, but the guilt of this can still be crushing.

1.  Do visit when you can, but always ask the patient if they’re up for it. Visitors are a source of support and they break up the monotony of the daily hospital routine. I love getting visitors.

2.  Do send flowers and cards. Not only is it a nice gesture and brightens the room, but is normalizes the experience of being in a hospital as a psychiatric patient (in this day and age there should be no difference between how psychiatric and physical patients are treated, but that’s a whole other blog topic).

3.  Do ask if they need anything while in the hospital like magazines, a favorite snack or if a simple job needs to be done around the house. Continue that care when they’re initially out of hospital like you would for someone with a broken leg. It’s hard getting back on your feet and into your regular routine once you’ve been discharged, so a little extra help is often needed. You don’t need to spend all of your time caring for the person, but little thoughtful gestures go a long way.

4.  Do bring fun activities into the hospital. As I said, hospital can be pretty boring. I don’t know how many hours I whittled away playing monopoly or cards with friends, or just coloring on my own. These help to pass the time. Of course, some patients may not be up to playing games, it just depends on the patient’s current situation.

5.  Do validate! Never underestimate the power of validation. If someone is depressed, instead of responding with pity or an upbeat (and often corny) saying, say: “That sounds really tough” or something similar. If someone is psychotic, then their psychosis is as real to them as whatever’s going on in your life. Don’t dismiss it. Listen to them and take what they have to say seriously.

6.  Do treat the person the same as you would when they’re well. Your loved one is still in there and no matter how unwell they are, they will know if you’re treating them differently. When I’m psychotic, although I lose touch with reality, I still retain my intelligence and empathy and I can tell if people are treating me differently. When they do, it makes you feel misunderstood, isolated, paranoid and alone.

7.  Do acknowledge we’re unwell, stay in touch and offer to help out. The biggest detriment to us when we’re unwell is silence — like our mental illness is taboo. Silence adds to stigma and prevents people seeking early treatment, or stops them from seeking it at all. Ask how we’re feeling like how you would ask someone who has pneumonia how they’re feeling. Ask genuine and honest questions with interest. Sometimes questions are all that’s needed for us to open up. Again, just simply talking about mental illness normalizes it. We don’t want our condition to be swept under the rug it when it flares up. We want to talk about it with the people we trust.

And finally…

8.  Do treat mental illness the same as physical illness! After all mental illness is a physical illness – it just occurs in the brain. If you treat the patient with compassion, unwavering love and support, humor (again, gauge the situation) and show genuine, non-judgmental interest in what they’re experiencing, they’ll feel supported and loved. And in the end, that’s what we all want when we’re unwell.

This piece originally appeared on the International Bipolar Foundation’s blog .

The Mighty is asking the following: Create a list-style story of your choice in regards to disability, disease or illness. It can be lighthearted and funny or more serious — whatever inspires you. Be sure to include at least one intro paragraph for your list. If you’d like to participate, please send a blog post to [email protected]. Please include a photo for the piece, a photo of yourself and 1-2 sentence bio. Check out our Submit a Story page for more about our submission guidelines.

Sally Buchanan-Hagen is a registered nurse and works in the emergency department. She also teaches undergraduate nursing students Mental Health Nursing and is a Consumer Academic. Sally was diagnosed with bipolar type I disorder when she was 22 and is now passionate about mental health promotion. She blogs for The International Bipolar Foundation and bphope. She has also written for The Change Blog, Youth Today, upstart, and the print magazine “Better Mental Health Magazine.” Sally volunteers for the Black Dog Institute in the roles of Youth Presenter and Community Presenter.

Lorien Psychiatry

Scott Siskind, MD

• March 30, 2021
• Uncategorized

Guide To Navigating Psychiatric Inpatient Care

The short version: People can go to psychiatric inpatient units voluntarily, or be involuntarily committed if someone thinks they could potentially harm themselves or others. Usually this involves a ~12-hour emergency room stay, followed by ~3-5 days in a hospital ward. Once doctors believe the patient is safe, they will discharge them, possibly but not necessarily after having given them some quick treatment. There is not much patients can do to speed this process up besides cooperating, but there are some things they can do to make it more likely that people will respect their rights. People who need long-term or complex treatment should ask about other arrangements for after they get out of inpatient.

The long version:

1: What is psychiatric inpatient care?

Outpatient care is when you have a brief appointment with your doctor, then go back home. Inpatient care is when you stay in the hospital for multiple days receiving treatment. So psychiatric inpatient care is the kind of care you would get in a psychiatric hospital, or in the psych ward of a regular hospital.

Some people seek out inpatient care because they are feeling very unwell. Other people are involuntarily forced into inpatient care, usually by the police.

2: I’m wondering if I should voluntarily seek inpatient care. What are the advantages and disadvantages?

Most inpatient units specialize in treating patients who would be unsafe outside of them – either they’re suicidal, they’re violent, or they’re so out-of-touch with reality that they might do dangerous things like run into traffic. Their first goal is protection; making sure these people can’t hurt themselves or others. Their second goal is treating psychiatric problems to the point where people would be safe leaving.

With a few exceptions, they don’t have any special tools to treat psychiatric conditions beyond what an outpatient psychiatrist has – they use the same antidepressants and antipsychotics as anyone else. They also have major disadvantages over an outpatient doctor. The living conditions are often cramped and substandard, there can be strange and scary people there, and there’s a prison-like atmosphere where nurses and orderlies keep a close watch on everyone. The doctors there are often overworked, hardened by years of working with confrontational people, and not very good at communicating effectively. They don’t have to let you out until they feel like letting you out, and they’re not always good at communicating what would make them feel like that.

If you feel completely safe outside an inpatient unit, and you’re getting good outpatient care, you probably won’t want to go to a inpatient unit.

If you feel like you’re at risk of hurting yourself or someone else, or you don’t know how else to get care, or you’re really desperate and don’t know what else to do, you might be a good candidate for inpatient care.

Inpatient care does have some advantages! It gets you away from wherever you were before, which might be a stressful or abusive situation. It gives you the chance to attend very intensive therapy groups, sometimes several times a day, where you can learn more about mental health. It can help you connect with social workers who can help you get insurance, make connections with therapists, and find you the social services you need. It’s got enough monitoring that psychiatrists there feel comfortable starting you on much stronger medications much faster than you would get outside. And most important, it’s really hard to kill yourself or someone else there, so if you’re worried you might do that, then definitely go.

But keep in mind that modern inpatient care is a revolving door system. The most likely outcome is that you stay there three days or so, have a moderately bad time, get over whatever crisis brought you in there just by putting time and space between yourself and the problem, and then discharged on slightly different medication than you came in on. You’re unlikely to get a deep analysis of what’s going on with you or especially high-quality suggestions for how to fix it (besides suggestions of outpatient programs you can try later).

One other disadvantage of inpatient care: it’s pretty costly, with even short admissions going into the thousands of dollars. Different insurances will cover different amounts of this.

— 2.1: If I do decide to seek inpatient care, what does the process look like?

If you feel too unwell to drive or arrange transportation, call 9-1-1 and tell them you need inpatient care. They will dispatch someone to bring you to a hospital emergency room.

If you feel up to driving or arranging transportation, then go to the emergency room of your local hospital and tell them your concerns.

Consider packing useful things before you go. This could include a few changes of clothing, fun things to pass the time, and phone numbers of important people (it’s not enough that they’re in your cell phone; your cell phone will be confiscated). Keep in mind that anything you bring with you could be confiscated before you go into the psychiatric hospital. Electronics like cell phones and computers definitely, but random other things could be too – for example, pillowcases are a strangulation risk (really!). Psychiatric hospitals have about a 95% – 98% success rate in giving back the things they confiscate after patients get out, so don’t bring anything too valuable.

Once you’re in the emergency room, expect to wait a long time. However long you think this means, expect it to be longer than that. You’ll be on a bed in a kind of scary environment without very much to do. Because of the laws around hospitals and psychiatric patients, once you go in the ER you probably won’t be allowed to leave, even if you change your mind and decide you don’t need care anymore. After some number of hours, you’ll get evaluated by some series of people, usually including a nurse and a psychiatrist, but also possibly including medical students, social workers, and random other doctors. Expect the process to take the better part of a day.

— 2.2: Who decides if I get accepted to an inpatient unit?

You are not guaranteed admission to the unit just because you want it. You might be turned down if the psychiatrist thinks you aren’t sick enough to need it, or if your insurance refuses to pay for it. Insurance companies are very reluctant to pay for hospitalizations unless there is a clear risk involved, so explain what the risk is.

The only thing that (almost) always works is mentioning suicide. If you say you’re suicidal, you’ll get admitted, so if that’s part of the problem, emphasize it. Stress that you are suicidal. Stress that it’s not just the occasional fleeting thought, but actually something that you might really go ahead with. If you have a plan, share it.

If you’re not suicidal, expect to have to argue. Talk about what you’ve already tried and why it didn’t work. Talk about all the damage your mental illness has caused in your life. If there’s any chance you might snap and do something horrible – hurt someone, hurt yourself, have some kind of spectacular breakdown – play it up. If you have to, say something vague like “I don’t know what I would do if I couldn’t get help”. Be ready for this not to work, and for the psychiatrist evaluating you to recommend you go to an outpatient psychiatrist.

If you really want help beyond the level of outpatient treatment, but your insurance company won’t budge, ask about a partial hospital program. This is something where you go to a hospital-like environment from 9 to 5 for a few weeks, seeing doctors and getting therapy and classes, but you’re not involuntarily committed and you go home at night. Sometimes insurance companies will be willing to do this as a compromise if you are not suicidal.

— 2.3: How should I decide which psychiatric hospital to go to?

If it’s an emergency, the answer is “whichever one is closest” or even “whichever one the ambulance you should call right now takes you to.”

If you have a little more leeway, and you have a competent outpatient psychiatrist whom you trust, ask them which one to go to. They will probably be familiar with the local terrain and be able to give you good advice.

If you live in a big city with wealthier and poorer areas, and it’s all the same to your insurance company, try to go to a hospital in the wealthier area. Not only do wealthier people always get nicer things, but – and sorry if this is politically incorrect – you would rather be locked up for a week with the sorts of people who end up in wealthy-area psychiatric hospitals than with the sorts of people who end up in poor-area psychiatric hospitals.

US News & World Report ranks the best psychiatric hospitals . They’re mostly looking at doctor prestige, but I would guess this correlates with other factors patients want in a hospital. If you’re really prestigious you have a lot of money and a lot of eyes watching you, and that probably helps. I suspect teaching hospitals are also good, for the same reason. But these are just guesses.

If you have no other way of figuring this out, you can try looking at Psych Ward Reviews . This site is underused and suffers from the expected bias – you only write about somewhere if you don’t like it – but it’s better than nothing.

Keep in mind that sometimes hospitals will be full, and they will send you to a different hospital instead, and you won’t have any say in this.

3. I’m worried about being involuntarily committed to a psychiatric inpatient unit. How can I avoid this?

Most people who express this concern are worried that their psychiatrist or therapist might commit them.

In theory, psychiatrists and therapists are supposed to provide voluntary treatment, with risk of involuntary commitment only in certain very clearly delineated situations that you can understand and avoid. Each state’s laws are slightly different (and I can’t say anything about non-US countries), but they tend to allow involuntary commitment only in cases of immediate risk of hurting yourself, hurting someone else, or being so psychotic that you could plausibly hurt someone by accident (eg you jump out of a window because you think you can fly).

The key word is “immediate”. If you just have occasional thoughts about suicide, or you have some limited hallucinations but remain grounded in reality, according to the law this is not enough to involuntarily commit you.

In practice, not every mental health professional knows the laws or interprets them the same way, so they can just commit you anyway. The check on this is supposed to be that you can sue them when you get out of the hospital, but almost nobody bothers to do this, and judges and juries usually find in favor of the mental health professional.

So the law isn’t as much protection as it probably should be. In reality your best protection is to only open up to competent people whom you trust, and to frame what’s going on in a way that doesn’t scare them unnecessarily.

Don’t joke about committing suicide. Don’t bring up occasional stray suicidal thoughts if they don’t matter. Don’t say something like “I think about suicide sometimes, but doesn’t everyone?”, because your psychiatrist will have heard the last ten people answer “No, of course I never think about suicide”, and they will not be impressed with your claim about the human condition. Assume that any time you mention suicide, there’s a tiny but real chance of getting committed. If you are actually suicidal, take that chance in order to get help. Otherwise, this is really not the time to bring it up. If you wouldn’t offhandedly chat about terrorism with an airport security guard, don’t offhandedly chat about suicide with a psychiatrist.

(none of this applies to competent psychiatrists whom you trust, but award this status only after many positive experiences over a long-term relationship)

If your psychiatrist asks you outright if you ever have suicidal thoughts, well, tough call. If you don’t, then say you don’t. If you mostly don’t but you are some sort of chronically indecisive person who has trouble giving a straight answer to a question, now is the time to suppress that tendency and just say that you don’t. If you do, but you would never commit suicide and it’s not a big part of why you’re seeing them and you don’t mind lying, you can probably just say you don’t. If you do, and it’s important, and you don’t want to lie about it, then make sure to be very specific about how limited your thoughts are (eg: “I only thought that way once, three years ago) and to add as many of these as are true:

1. “Of course I would never go through with it, but sometimes I think about…” 2. “I love my friends/family/partner/pet too much to ever go through with it.” 3. “I don’t have any plans for how I would do it.” 4. “I’m [religion], and we believe that God doesn’t want us to commit suicide.” 5. “I’ve been thinking about it for [long time], but the thoughts haven’t gotten any worse lately.”

The same applies to hallucinations and other signs of psychosis. Most people have very minor random hallucinations as they are going to sleep. Most people hear their own thoughts as silent “voices” in their head at least some of the time. Most people who take hallucinogenic drugs will hallucinate. You don’t need to bring these up when someone asks you about hallucinations. If you actually have some troubling psychotic symptoms, then mention them, but add as many of these as are true:

1. “Of course, I know these aren’t really real.” 2. “These have been going on for a while and aren’t any worse lately.” 3. “I would never listen to anything the voices say.” 4. “I only get that way when I’m on drugs / really tired / under a lot of stress.”

If you do all of these things, your chance of getting involuntarily committed to a psychiatric hospital by an outpatient provider is probably one percent or less, unless you’re really really sick.

Notice the words “by an outpatient provider” here. None of this applies if you are in a hospital (eg with pneumonia). If you are in a hospital, be extra careful about this to the point of paranoia. Unless you’re really worried that you might go through with suicide, be careful about mentioning it at the hospital. Get your pneumonia or whatever treated, and then go out of the hospital, find a competent outpatient psychiatrist whom you trust, and open up about your issues to them. If you decide to open up to the nurse-assistant giving you a three question psychiatric screen in the pneumonia ward, you may end up on a psychiatric unit regardless of how careful you are, because hospitals don’t take chances.

The same is true of ERs. If you go to the ER with a psychiatric problem, expect a medium chance that they will involuntarily commit you, even if it’s a minor problem and you don’t meet the criteria.

— 3.1: I do need to go to an inpatient unit, but I want to make sure I’m admitted voluntarily instead of involuntarily. How can I make sure this happens?

I want to be really clear on this: in your head, there might be a huge difference between voluntary and involuntary hospitalization. In your doctor’s head, and in the legal system, these are two very slightly different sets of paperwork with tiny differences between them.

It works like this, with slight variation from state to state: involuntary patients are usually in the hospital for a few days while the doctors evaluate them. If at the end of those few days the doctors decide the patient is safe, they’ll discharge them. If, at the end of those few days, the doctors decide the patient is dangerous, the doctors will file for a hearing before a judge, which will take about a week. The patient will stay in the hospital for that week. 99% of the time the judge will side with the doctors, and the patient will stay until the doctors decide they are safe, usually another week or two.

Voluntary patients are technically allowed to leave whenever, but they have to do this by filing a form saying they want to. Once they file that form, their doctors may keep them in the hospital for a few more days while they decide whether they want to accept the form or challenge it. If they want to challenge it, they will file for a hearing before a judge, which will take about a week. The patient will stay in the hospital for that week. 99% of the time the judge will side with the doctors, and the patient will stay until the doctors decide they are safe, usually another week or two.

You may notice that in both cases, the doctors can keep the patient for a few days, plus however long it takes to have a hearing, plus however long the judge gives them after a hearing. So what’s the difference between voluntary and involuntary hospitalization? Pride, I guess, plus a small percent of cases where the doctors just shrug and say “whatever” when the voluntary patient tries to leave.

Some decent fraction of the time, patients who intended to get voluntarily hospitalized end up involuntarily hospitalized for inscrutable bureaucratic reasons. The one I’m most familiar with is the ambulance ride: suppose the hospital you’re in doesn’t have any psychiatric beds available and wants to send you to the hospital down the road. For inscrutable bureaucratic reasons, they have to send you by ambulance. And for inscrutable bureaucratic reasons, any psychiatric patient transferred by ambulance has to be involuntary. Your doctors don’t care about this, because they know that there is no practical difference between voluntary and involuntary – but if you are still trying to maintain your pride, this might come as kind of a shock.

Some other decent fraction of the time, patients who ought to be involuntarily hospitalized end up voluntarily hospitalized for inscrutable bureaucratic reasons. The one I’m most familiar with is doctors asking patients whom they are committing against their will to sign a voluntary form, ie “Agree to come voluntarily, or else I will commit you involuntarily”. This sounds super Orwellian, but it really is done with the patient’s best interest at heart. Involuntary commitments usually leave some kind of court record, which people can find if they’re searching your name for eg a background check – which could come up anywhere from applying for a job, to trying to buy a gun. Voluntary commitments usually don’t cause this problem. Even though nobody feels very warmly to the psychiatrist telling them to sign voluntarily or else, that psychiatrist is right and you should suck it up and sign the voluntary form.

If given a choice, you should sign voluntary, if only for the background-check reason above. But don’t count on getting the choice, and don’t get too attached to the illusion that it really matters in some deep way.

4. I have a friend/family member who really needs psychiatric treatment, but refuses to get it. What can I do?

The following section is about how this process works in most of the US. There will be some variation from state to state, and I don’t know anything about other countries.

If someone doesn’t want to go to the psychiatric hospital, see if they’re willing to see an outpatient psychiatrist, or if they have some good reason for refusing treatment. But if they’re refusing treatment because they’re out of touch with reality, or you think that their refusal of treatment is extremely unsafe, you might have to figure out how to to get them involuntarily committed to an inpatient unit.

Someone can be involuntarily committed to inpatient care if they are “a danger to themselves or others”, which usually gets broken down into three scenarios:

First, if they are likely to try to kill themselves in the near future.

Second, if they are potentially violent and might hurt other people.

Third, if they are so out of touch with reality that they might hurt themselves or someone else by accident. For example, if they try to jump off a roof because you think you can fly. Or if they don’t eat, because they’re not thinking clearly enough to remember that they need food to live.

If the person you know fits one of those criteria, ask them to let you take them to a psychiatric hospital. If they refuse, and you’re sure they need to go, call 911 and ask the police to bring them to the hospital.

What if the person you know doesn’t fit those criteria, but is still clearly not mentally well? The most common example of this situation is someone who has just had a psychotic break, and is (for example) huddling in a corner screaming that demons are attacking them, but not obviously about to hurt themselves or anyone else, and also they refuse to go to the hospital (maybe for a psychotic reason, like they think more demons are there).

This is a bad situation without easy options. Most of the time, police and hospitals will understand that someone like this needs care, and interpret the criteria broadly enough to cover cases like these. For example, can someone who hallucinates demons really be trusted not to jump off roofs or refuse to eat? Or what if they start thinking random passers-by are demons, and try to kill them? In most cases, hospitals will use loopholes like these to accept people who are genuinely psychotic and need help.

If you call the police, expect the police to show up prepared for confrontation. So, for example, lock your dog away somewhere where it can’t bother the police and the police can’t bother it. If the person involved resists, expect the police to use force to subdue them. Even if they don’t resist, expect that some police officers can be harsh and use methods that people will find disrespectful (for example, putting them in handcuffs). I’m not saying any of this will definitely happen, and most of the time police are able to bring people to the hospital without any trouble. But be prepared in case it does.

When they reach the hospital, a psychiatrist will evaluate them to see if they need to be committed. The person will probably say they don’t, so make sure that they have your side of the story too. The police will take some details, but you can also go to the hospital and give them your information directly. You may want to consider waiting until they have assigned a psychiatrist to do the evaluation, so you can talk to that psychiatrist, but expect this to take a long time (see section 2.1 above).

When talking to the psychiatrist or otherwise presenting your case, if you have reasons to think that the person meets any of the three criteria, mention them. Mention anything that made you think they might hurt themselves, or hurt someone else (eg you), or that they are too out-of-touch-with-reality to be trusted to keep themselves safe. If you don’t have anything like that, just mention whatever is most concerning to you.

— 4.1: What if I tried this, but the police wouldn’t take them, or the hospital wouldn’t commit them?

There’s no good solution to this besides waiting to see how the person does, and trying again if they get worse.

— 4.2: Okay, they’re in the hospital, now what?

The most common way this ends is that your family member goes to the hospital, is started on some drugs, gets a little better, goes home, stops taking the drugs, and gets worse again. If the doctors at the hospital aren’t very competent, they may not think about this. It may end up being your job to insist on some kind of longer-term solution.

If your family member is psychotic, then the gold standard for longer-term solutions is a long-acting injectable antipsychotic medication. This is a shot that a nurse can give them which will give them a few months’ worth of antipsychotics all at once, safely. This way they don’t have to remember/agree to take their medication at home. Then a few months later you can wrangle them back to a doctor’s office where someone can give them the shot again; repeat as needed. If your family member doesn’t agree to this, you’re going to need a judge’s order – but judges are really cooperative with this kind of thing and your psychiatrist can tell you more about how to make this happen. A partial hospital program can also help with this.

There’s a kind of institution with different names everywhere, usually something like “Assertive Community Treatment”, which basically consists of some mental health professionals in a van who go around to people’s houses and make sure they’re okay / staying on medication after they’ve been discharged from the hospital. These are chronically underfunded and you have to fight to get into them, but if nothing else works you can see if there’s one of them in your area. These people are also good at wrangling patients to get their monthly dose of long-acting injectable antipsychotics.

You can get a lot more advice from the Treatment Advocacy Center , a non-profit that helps people figure out how to get their friends and family members psychiatric treatment.

5: I’m in a psychiatric inpatient unit and I want to leave. How can I get out as quickly as possible?

Good news: average stays for psychiatric hospitals have been decreasing for decades, and are now usually a week or less. I did a study on the hospital I worked in and came up with an median stay of 5.9 days, and remember that there are a lot of really sick people bringing up those numbers.

(there are a few states that have laws centered around the number “three days”, but there are also a lot of states that don’t. For some reason the “three days” number has leaked into the general consciousness and everyone expects that to be how long they stay in the hospital. Don’t necessarily expect to get out of the hospital in exactly three days, but do expect it will be closer to 5.9 days than to weeks or months.)

Even better news: contrary to rumor, psychiatrists rarely have a financial incentive to keep people hospitalized. In fact, most hospitals and insurances now encourage quick “turnover” to “open up beds” for the next group of needy patients, and doctors can get bonuses for getting people out as quickly as possible. This should worry everyone else in the hospital who’s getting treated for pneumonia or whatever, but from the perspective of a psychiatric patient who wants to leave quickly it’s pretty good.

If you have a good doctor, you should trust their judgment and do what they say. But if you have a bad doctor, then the only thing you can count on is that they will respond to incentives. Their incentive to get you out quickly is the hospital administrators and insurance companies breathing down their neck. Their incentive to keep you longer is that if you get out of the hospital and ever do anything bad, they can get sued for “missing the signs”. So their goal is to do a token amount of work that proves they evaluated you properly so nothing that happens later is their fault.

That means they’ll keep you for some standard time interval, traditionally (though not always) three days, just so they can say they “monitored” you. If you seem unusually scary in some way, they might monitor you a little longer, up to a week or two. Your chances of successfully convincing them not to do this are essentially nil. Imagine you kill someone a few weeks after leaving the hospital, and during the trial the prosecutor says “The patient was taken to St. Elsewhere Hospital for evaluation of mental status, but discharged early, because he said he didn’t want to have to sit around and be evaluated for the usual amount of time, and his doctor thought this was a reasonable request.” Your doctor is definitely imagining this scenario.

Instead of pleading with your doctors to let you go early, just do everything right. Have meals at mealtime. Go to groups at group time. Groom yourself, not just because you look saner when you’re well-groomed, but because there will actually be nurses monitoring your grooming status and reporting it to the psychiatrists making release decisions. When people tell you things you should do after leaving the hospital, agree that you will definitely do them. If people ask you questions, give reassuring-sounding answers.

For this last one – don’t contradict evidence against you, don’t accuse other people of lying, just downplay whatever you can downplay, admit to what the doctors already believe, and make it sound like things have gotten better. For example, if you were found lying face-down with an empty bottle of pills next to you, don’t say “I didn’t attempt suicide, I just tripped and the pills fell into my mouth!” (I have seriously had patients try this one on me). Don’t say “It was my girlfriend’s fault, she drove me to do it!” Just say something like “That was a really bad night for me, and I don’t remember exactly what happened, but now I’m feeling a lot more hopeful, and I think that was a mistake.”

Don’t overdo it. Nothing is more annoying than the person who’s like “The twenty minutes I’ve been talking with you so far have turned my life around, and now I realize how wrong I was to reject God’s beautiful gift of existence, and am overflowing with abounding joy at the prospect of getting to go back into the world and truly confront my problems with the help of my loving family and…” Just be like “Yeah, things were rough, but I feel a little better now.”

Most important, take the drugs .

Yes, I know that some psychiatric drugs are unpleasant or addictive or dangerous or make you feel awful. I’m not challenging your decision not to want to be on them. But take the drugs while you’re in the hospital, for 5.9 days. Then, when they let you out, decide if you still want to continue. I guarantee you this will be easier for you, for your psychiatrist, and for the various judges and lawyers involved. The alternative is that you refuse to take the drugs, somebody has to set up a court hearing to get an involuntary treatment order, you have to sit in the hospital for weeks while the legal system gets its act together, the psychiatrists finally get the order and drug you against your will, and then after however many weeks or months, you get released from the hospital and stop taking the drugs.

If you have a good doctor whom you trust, then talk to them about the drugs and make a decision together. Let them know if there are any side effects. If a drug isn’t working for you, tell them, so they can switch it. Be honest, and willing to stand up for yourself, but also open-minded and ready to listen.

But if you have a bad doctor, just take the drugs. Bring up side effects, mention anything that’s intolerable, but when – like bad doctors everywhere – they ignore you, just take the drugs. Then, when you get out of the hospital, go to a competent outpatient psychiatrist whom you trust, tell them the drugs aren’t right for you, and talk it over with them until you come up with a better plan.

This is a good general principle for everything: agree to whatever people ask you while you’re in the hospital, talk to a competent outpatient psychiatrist whom you trust once you get out, and decide which things to stick to. I remember working with a doctor who wanted to discharge his patient to some kind of outpatient drug rehab. The patient refused to go, so the doctor wouldn’t discharge her, and they were in a stalemate over it for weeks, and the whole time the patient was tearfully begging the doctor to release her. I cannot tell you how much willpower it took not to sneak into the patient’s room and yell at her “JUST AGREE TO GO TO THE REHAB AND THEN DON’T DO IT, YOU IDIOT”. I mean, I am as in favor of Truth as everyone else, but I don’t even think her doctor cared if she went to the rehab or not. He just wanted to be able to document “Patient agreed to go to rehab”, so that when she started taking drugs again, he would have ironclad court-admissable evidence that it wasn’t his fault.

Finally, your doctors will be very interested in “discharge planning”, ie making sure you have somewhere safe to be after you leave the hospital. They may not be willing to believe you about this. So get a family member (best) or friend (second-best) on your side. Have them agree to tell the doctors that they will watch over you after you leave, make sure you take your medication, make sure you get to your follow-up outpatient psychiatrist appointments, make sure you don’t take any illegal drugs. Your best bet for this is your mother – psychiatrists love mothers. Tell your doctors “I talked to my mother, she’s really concerned about my condition, she says that I can stay with her after I leave and she’s going to watch me really closely and make sure I’m okay”. Only say this if it’s true, because your doctors will call your mother and make sure of it. But if you can make this work, this is really helpful.

Even if all of this works, it’s just going to get you out of the hospital in a bit less than 5.9 days instead of a bit more than 5.9 days. There’s no good way to get out instantly. Sorry.

— 5.1: I’m in a psychiatric inpatient unit and I think I’m being mistreated. What can I do?

Your best bet is to find someone with a position like “Recipient Rights Representative” or “Patient Rights Advocate”. Most states mandate that all psychiatric hospitals have a person like this. Their job is to listen to people’s concerns and investigate. Usually the doctors hate them, which I take as a pretty good sign that they are actually independent and do their job. If you haven’t already gotten a pamphlet about this person when you were admitted, ask the front desk or your nurse or someone else who seems to know what’s going on how to contact this person.

You may be able to switch doctors or nurses. Just go to the front desk or someone else official-looking and ask. I don’t think this is a legally codified right, but sometimes nobody cares enough to refuse. Keep in mind that if you switch doctors, you may have to stay longer so that the new doctor can do their three-day-or-so assessment of you, separate from the last doctor’s three-day-or-so assessment.

Threats don’t work. Everybody makes threats, and everyone at the hospital is used to them. Threatening to hire a lawyer is especially boring and overdone and will not even get anyone’s attention.

Actually hiring a lawyer will definitely get people’s attention, but it’s a high-variance strategy. Remember that it’s very hard to get a doctor not to hold you for a three-day-or-so evaluation, and that most people are released before anything goes to court anyway (a court hearing can take weeks to set up). I have mostly seen this work in cases where I have no idea what the doctors are thinking and everybody seems sort of confused and just letting the patient sit in the hospital for no reason. Lawyers can be a very good incentive for people to un-confuse themselves. I am not a lawyer, I have tried to avoid the state of prolonged confusion where lawyers become necessary, and I don’t want to give any legal advice beyond saying it will definitely get people’s attention. But I would feel bad if someone read this, hired a lawyer, found them not to be genuinely helpful (as in fact they probably will not be), and then got a huge legal bill.

Some people wait until they get out, then comparison-shop from the outside world and hire a lawyer to sue the people who mistreated them in the past. If you’re going to do this, document everything. Your doctors are documenting everything, and if one side comes in with perfect documentation and the other side just has vague memories, the first side will win. By “document everything”, I mean have a piece of paper where you write down things like “2:41 PM on October 10: Nurse Roberts threw a pencil at me. Informed such-and-such a person and they refused to help. Informed such-and-such another person and they also refused to help.” Write down exactly where and when everything took place – the psychiatric hospital may have video surveillance, and if everybody knows which videos to get, it will make life much easier. Report everything to the Patient Rights Advocate, even if they’re useless, just so you can call them up and have them testify you reported it to them at the time. I am not a lawyer, this is not legal advice, and your lawyer will be able to tell you much more – but documentation never hurts.

If things are really bad, figure out if there are surveillance cameras, and hang out in front of them.

Once you leave the unit, consider giving feedback. Most hospitals will have some kind of survey or hotline or something that lets you praise hospital staff whom you liked and report hospital staff whom you didn’t like. This won’t heal any wounds you suffered – and while in the hospital, threatening to report a doctor will be ignored just like all threats – but it might help somebody way down the line. You can also write a report on Psych Ward Reviews . In fact, do this anyway, whether you’re mistreated or not, so that other people can learn which hospitals don’t mistreat people.

— 5.2: I had a terrible time in an inpatient unit, but now I’m out. Should I be worried? Are they going to bring me back if I don’t keep taking my drugs?

The moment you leave an inpatient unit, your inpatient doctors and nurses forget all about you. They’re not breathing down your neck waiting for any excuse to bring you back. They’re not plotting ways to punish you for any fights you had during your time in the hospital. However big a deal your stay was for you, your doctors and nurses have already forgotten about it and moved on to the next patient.

Nobody is watching to make sure you keep taking the drugs. Nobody is watching to make sure you go to whatever programs you said you would go to. If you are one of the extremely rare exceptions, usually because the legal system has gotten involved, the legal system will make super-clear that you know this. Otherwise, there’s no reason to worry about going back to the hospital unless someone calls the police on you again. Even if you do get committed again, it will often be a totally different doctor or hospital, or the doctor you have such strong trauma around won’t even remember you.

6. I think my friend/family member is in a psychiatric inpatient unit, but nobody will tell me anything

Yes, this definitely sounds like the sort of thing that happens.

Because of medical privacy laws, it is illegal to tell a person’s friend or family that they are in the psychiatric hospital, or which psychiatric hospital they’re in, without their consent. If the person is too paranoid, angry, or confused to give consent, then their friends and family won’t have a good way to figure out what’s going on.

Your best bet is to call every psychiatric hospital that they could plausibly be in and ask “Is [PERSON’S NAME] there?” Sometimes, all except one of them will say “No”, and one of them will say “Due to medical privacy laws, we can’t tell you”. I know this sounds ridiculous, but it really works.

Once you have some idea which hospital your friend is in, call and ask to speak to them. They will say something like “Due to medical privacy laws, we can’t tell you if that person is here.” Say “I understand that, but could you please just ask them if they’re willing to speak to me right now?” If they are willing to speak to you, problem solved. Otherwise, you might still get some information based on whether the person leaves you on hold for a while in a way that suggests she’s going to your friend and asking them whether they want to talk to you.

You can also ask to speak to (or leave a message for) the doctor taking care of your friend. The receptionist will say “Due to medical privacy laws, we can’t tell you if that person is here.” Say “I understand that, but I have some important information about their case that I want the doctor to know. They don’t need to tell me whether my friend is there or not, just listen.” At this point, all but the most committed receptionists will either admit that your friend isn’t there, or actually get a doctor or take a message. There is no doctor in the world who is so committed to medical privacy that they will waste time listening to the history of a patient they don’t really have just to maintain a charade, so if you actually get a doctor this is a really strong sign.

Once you have a good idea where your friend is, you can ask the receptionist to pass a message along to them, like “Call me at [this phone number]”. If they still don’t respond – well, that’s their right.

Most hospitals will have visiting hours. Going to visit someone who refuses to let you know they’re at the hospital and refuses to give anyone consent to talk to you is a high-variance strategy, but you can always try.

— 6.1: My friend/family member is in an inpatient unit and wants to get out as quickly as possible. How can I help them?

First, make sure they actually want to get out as quickly as possible, and you’re not just assuming this. You would be surprised how many people miss this step.

Second, make sure they know everything in section 5 here.

Third, offer to talk to the doctors. Doctors often don’t trust mentally ill patients, but they usually trust family members. If your friend isn’t sick enough to need to be in the hospital, tell the doctors that. Describe the circumstances around their admission and why it’s not as bad as it looks. Mention how well you know the person, and how you’ve been with them through their illness, and how you know they would never do anything dangerous. Only say this if it’s true – if they’re in the hospital for stabbing a police officer, your “they would never do anything truly dangerous” claim won’t be taken seriously.

Offer to help with discharge planning (see the end of section 6). Tell them that the patient will be staying with you after they leave the hospital, that you’re going to be watching them closely to make sure that they’re safe, that you’ll make sure they take their medications and go to followup appointments. Again, only say this if it’s true – or at the very least, coordinate with the patient, so you don’t say “My son will be staying with me under my close supervision.” and then your son ruins it all by saying “Haha, as if.”

If you have a sob story, tell it. If you are ninety-seven years old and your son is the only person who is able to take care of you and bring you to your doctors’ appointments, mention that. Sob stories from patients generally don’t work, but sob stories from family members might.

Offer to come to the hospital during visiting hours and meet with the doctors. This both underlines everything above – it shows you’re really invested in their care – and also gives you a good opportunity to pressure the doctors face to face. I don’t mean you should threaten them or be a jerk about it, but just ask “Why can’t Johnny come home? We really need Johnny at home to help with the chores. Everyone at home misses Johnny.” I don’t guarantee this will work, but it will work a little, on certain people.

If there are many people in your family who are willing to work on this, use whoever is closest to the patient (eg their mother) – and in case of a tie use the person who is the most upstanding high-status member of society. A promise to take care of someone sounds better coming from a family member who is a doctor themselves (or a lawyer, or a teacher) compared to from the patient’s unemployed stoner brother with a NO FEAR tattoo.

As somebody who is not in a psychiatric hospital, you are in a much better position to hire a lawyer if one needs to be hired. Again, in the majority of cases a patient won’t even stay long enough to have a court hearing. If you are poor and have limited resources, this is definitely not how I would recommend using them. But if you have money to burn, or your friend/family member is being held for an inexplicable amount of time (longer than a week or two) and you don’t know why, you are going to be in a much better position to take care of this than the patient themselves.

Even if all this works, it’s just going to make someone stay a bit less than 5.9 days instead of a bit more than 5.9 days. There’s no good way to get someone out instantly.

7. How will I pay for all of this?

If you don’t have health insurance, there is usually some kind of state/county mental health insurance program that is supposed to help with this kind of thing. You usually have to earn below a certain amount to qualify. Your social worker at the hospital can talk to you about this. I am not promising you such a program will exist – if you’re concerned about money, look into this before you go to the hospital.

If you do have health insurance, they may pay for your admission. The problem is that they have to decide if you are really ill enough to need psychiatric care, and they make this determination separately from the doctors who decide whether to commit you or not. In the worst case scenario, you can be involuntarily committed because your doctors decided you needed care, but your health insurance refuses to pay for it because they decided you didn’t need care. If this happens, you are stuck with the bill. This is horrifying and there should be some kind of law against it, but I’ve seen it happen and I think it’s legal.

Your best bet in these cases is to try to get the state/county mental health insurance mentioned above. Sometimes you can sign up for it after you leave the hospital, and then get your costs reimbursed.

If everything goes wrong, and you’re stuck with a bill and no insurance company willing to pay it, try to argue the hospital down. Hospitals know that the average random sick person can’t afford to pay $20,000 or whatever ridiculous amount they charge. They make these numbers up as part of a complicated plot to fool insurance companies into overpaying, which never works, and they expect patients to try to bargain. They are also usually willing to consider whatever payment plan you think you can make work. I don’t know very much about this, but there’s some more information here.

As far as I know, committing people involuntarily and leaving them with a huge bill is legal, and hiring a lawyer will not help with this. I don’t know much, so you may want to ask a lawyer’s opinion anyway, if you can afford it.

8. Any other resources that can help me decide whether inpatient care is right for me?

You may want to read this survey from the blog Shrink Rap (warning: heavily selected population) where 147 people who were on inpatient units describe their experiences.

Life on a Psychiatric Ward: How Does One End Up There, and What Goes On?

What happens on a psychiatric ward? Considering that such a large proportion of the population suffer from mental health issues ( 1 in 4 is the oft-quoted statistic ), it surprises me how little is known about these clandestine microcosms.

Both in my current role as a consultant forensic psychiatrist, and my innumerate previous years of training, I’ve worked on dozens of wards; from the UK to Australia. As one might expect with a public service, the layout of the ward, the quality of care and the ward routine varies significantly between disparate wards. As does the atmosphere.

So, how do people end up on these psychiatric wards? In essence, in the UK, when there are serious concerns about an individual’s mental state, this is brought to attention by another professional (e.g., a social worker or a general practitioner), a family member, or even by the patient themselves. There are numerous forms of deterioration that can raise concerns. For example, somebody could be severely depressed with thoughts of suicide , or lacking the volition to eat. Someone could be very paranoid to the extent that they are uncharacteristically aggressive or even violent. Somebody with dementia could be wondering onto the streets with no regard for their own safety. These are all examples of patients who, on balance, are unlikely to be able to cope or function in the community.

What does being sectioned involve? No men in white coats. No straight jackets. No big van. Lots of paperwork. Detaining or ‘sectioning’ somebody under the provisions of the Mental Health Act is a serious, detailed and time-consuming process. It is never done flippantly. Stringent procedures follows strict guidelines. The assessment of the patient must be carried out by two senior doctors, who are independent of each other as well as an experienced social worker (known as an approved mental health practitioner ). These professionals have to undergo rigorous training to gain in-depth knowledge of the Act. It’s not enough that the professionals want to detain the patient in order to treat them. They must prove that they believe the patient needs to stay in hospital for their own health, or their own safety or because someone else’s safety would be under threat if they were released. Indeed, there are hundreds of people with active symptoms of mental illness, who are not a danger to anybody. They survive perfectly well without their freedom being restricted. And rightly so. The professionals also must also prove that the patient would not recover without this enforced treatment, and that there isn’t a less restrictive option. 

Contrary to what many films depict, all the patients on a psychiatric ward are not there against their will. In my experience, on general adult wards around half to two-thirds of inpatients are sectioned. The others are there as a voluntary ‘informal’ admissions, which means they have the right to leave or to refuse treatment. However, in the locked secure psychiatric wards that I work in currently, all the patients have a history of violence, and therefore have to be sectioned; I talk about numerous anonymised case examples on my YouTube channel: A Psych for Sore Minds . 

As to what kind of mental illnesses tend to lead to psychiatric admission, in my experience, the majority of patients suffer from a psychosis like schizophrenia or a mood disorder such as severe depression or mania (when people with a bipolar illness are in a ‘high’ phase). However, I’ve also been involved with treating patients with more unusual psychiatric disorders such as catatonia (a severe psychosis which can render the patient completely mute and sedentary, as if paralysed), and AIDS-related early dementia.

What is life like on a psychiatric ward? Like all hospitals, psychiatric ones are places of healing. Depending on the profile and of the patients and the quality of the staff members, some wards can be peaceful and therapeutic. I’ve witnessed tremendous compassion , support, and camaraderie between the residents. Sometimes the most mentally unwell people find solace amongst those in similar positions. At times, some patients can be disturbed, and the ward can be chaotic. This is far more common within the secure wards for mentally disordered offenders that I work in now as a forensic psychiatrist.

So, what happens on psychiatric wards? People live there, and gradually recover. There usually are individual bedrooms as well as communal areas such as a lounges, with TVs, video games and a pool table. Patients live together, and some integrate well and support each other. Others may value their privacy and choose to isolate themselves. This could be related to mental illness (e.g., paranoid or negative thoughts ). Equally, it could just be down to personality.

There are nurses on site, 24 hours a day. I’ve worked in places with well-motivated and caring nurses who engage patients in conversation and therapeutic activities every day. Unfortunately, I’ve also worked in places where this doesn’t happen. Every patient has a consultant psychiatrist assigned to them; the boss. They are ultimately responsible for salient decisions such as medication , leave and discharge, though a good consultant will liaise with and seek counsel from the nurses and the rest of the team. Psychiatrists have many other duties outside the ward, such as outpatient appointments and home visits. Therefore, they tend not to be on the ward on a daily basis, but instead usually have weekly ‘ward rounds’; here, each patient is invited to discuss their progress and any issues. There are also junior doctors on the ward, who review the patients regularly and feed back to their consultant psychiatrist. They themselves are usually in training to become fully-formed psychiatrists one day.

Patients are served three meals a day. Most are given medication once or twice a day, though occasionally are offered some extra sedatives if they become particularly distressed. Therapeutic activities should be offered throughout the day. At least theoretically, there should be other staff members (known collectively as the multidisciplinary team ) that can contribute to various aspects of the patients’ recovery. They include psychologists who can meet them individually or in groups and use talking therapy and thinking exercises to help nurture insight and the ability to reflect on their mental illness, personality and behaviour; this might include figuring out triggers and risk factors to avoid future relapses. Occupational Therapists help provide activities including sports and art therapy. They can also help patients find work that is appropriate yet challenging, both inside the hospital, and in the long-term, after discharge. Social Workers help with a variety of issues such as communicating with family members, managing benefits and finances and finding appropriate accommodation for patients after hospital. All of this is available in an ideal world. But I’ve only ever worked in the real world, where some patients have to wait on the ward for weeks after their recovery to have their accommodation sorted, and some people never see a psychologist even though it would have been beneficial. Underfunded and under-resourced services lack necessities. This can make reintegration back into society much more of an uphill struggle for some people. 

Isn’t everybody just doped up on a psychiatric ward? Not at all. With new patients when the extent and type of illness is unknown, there tends to be a period of observation for several days or even weeks before a decision is made on what medication should be used, if at all. Ultimately these decisions are down to the treating Consultant Psychiatrist, but good practice is to start at low doses and increase gradually depending on response. The benefits and side effects of any medication varies significantly between patients, and are unpredictable. There is no right or wrong answer. Decisions are made from years of clinical experience. Treating mental illness is an art form as well as science. Over medicating patience is not a wise strategy, as the chances of the individual being compliant with tablets after discharge is low, often resulting in readmission and starting from square one. 

Is it true that people are locked up for years? Rarely. Length of admission varies significantly and depends on the situation. I’ve treated patients who have literally stayed for one night only; usually in the context of a crisis, or sometimes psychosis related to drug use, which resolves relatively quickly. Conversely, I’ve also seen patients with recalcitrant mental illnesses who lack insight or are unlucky enough to need several trials of medication before they find one that works effectively. They can have admissions that last several months, or even years. Some of the patients I worked with in Broadmoor hospital will likely never be discharged.

I discuss a whole range of mental health topics on my YouTube channel. Some videos are related to offending and violence, though others cover more common presentations.

Sohom Das, MD is a consultant forensic psychiatrist who lives and works in London. In his role, Sohom assesses and rehabilitates mentally disordered offenders in prisons, courts and in special secure psychiatric units that are reserved for the most dangerous and violent mentally ill patients.

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My First Night in a Psych Ward

Excerpt from "so-called normal: a memoir of family, depression and resilience.".

Posted November 26, 2020 | Reviewed by Ekua Hagan

Dr. Khouri asked me how often I’d been having thoughts of suicide .

“All the time,” I answered. “I have them every day.”

If this was what it was like to be a typical teenager , I didn’t want it. Gradually, I had lost the ability to ignore the thoughts. I couldn’t avoid them, un-think them, escape them by the stream in the forest. I’d been circling the drain for months.

That evening, after many hours in the emergency room—waiting to be seen, waiting to be assessed, waiting for a room assignment—I was transferred to a stretcher and wheeled down to the psych ward. I didn’t understand why that was necessary.

“There’s nothing wrong with your legs,” my mother would say when I asked her to do something for me that I could have easily done for myself. The staff at the hospital didn’t give me a choice.

“It’s procedure,” the nurse said.

Unit 1C was one of three psychiatric wards in the basement of the Cape Breton Regional Hospital. It was for the acute patients, less severe and persistent cases, though it was still a secure ward like the other two. We buzzed the intercom at the locked double door and waited for one of the night shift staff to let us in.

There was a fourth ward for mental health patients, but it was usually closed due to the staffing shortages that were common at the few remaining hospitals on the island. I noted that the cafeteria, and the exit should I need it, was a short distance down the dimly lit, cinder-block, pastel-painted hall—so it wasn’t all bad news. Across from the cafeteria was the morgue.

We arrived at Room 1034 at around 8 p.m.

My mother didn’t stay long but said she would come back to visit me the next day. The nurse who got me settled introduced herself as Jane. The deep, wise creases on Jane’s face were framed by a blond bob haircut. She looked a little like my sixth-grade teacher, Mrs. Peterson. I liked Mrs. Peterson, so by unconscious association I automatically liked Jane too. She was kind and welcoming.

When I first arrived, she had asked me all the same questions and took all the same notes as the psychiatrist before her, the crisis worker before that, the triage nurse before that and, informally, the guidance counsellor before that. It was my first time being admitted to a psychiatric ward, but I’d already repeated myself so many times that I almost had the questions, and the answers, memorized.

“I’m always thinking about killing myself,” I said to Jane.

I told her how I’d been more agitated and sensitive lately. She listened attentively, dutifully, then she searched me for contraband.

Things such as cigarettes and lighters weren’t allowed, which was fine since I didn’t smoke. Most pointy things, like pens, were banned too. Shoes with laces were a definite no-no. They had strict rules about what, and who, was allowed on the unit, and when.

She had me sign a number of papers, which she probably explained; it was all a bit of a blur that I didn’t really understand, including a disclaimer absolving the hospital of any responsibility in case anything was lost or stolen. She probably could have gotten me to sign just about anything—I was a desperate 14-year-old kid, alone on a psych ward in the middle of the night. I wasn’t exactly inundated by free will .

Nobody told me how long I’d be staying. When I asked, they were noncommittal about my commitment, ironically. “Well, that depends on how you’re doing,” the nurse said. “Don’t worry about that now.”

“Easy for you to say,” I thought, “you know when you’re leaving.” My antidepressant dose was increased, and a hypnotic was added to help me sleep. It made my mouth taste like metal.

I’d never been drunk before, but this was what I imagined being drunk felt like. I passed out and still felt woozy for a while after I woke up.

None of the wards were designated for children or youth. I shared a room with a much older man. When I arrived at the room, he was lying on his side, cocooned by blankets in his bed by the door. He didn’t move much until sometime after midnight, when he woke me up by suddenly sitting bolt upright in his bed and screaming, “We will overcome! We will overcome! We will overcome! We will overcome!”

His screams grew louder and more panicked with each incantation.

I woke up with a start, confused and afraid, but my body felt too heavy to get away or even protect myself. I was panicked but locked in.

Then, as suddenly as he sat up, he lay down again and went back to sleep. The room was silent again. Even medicated, I had a hard time going back to sleep.

Nobody had told me it was going to be like this.

“I don’t belong here. I’m not like these people,” I thought.

“I’m not crazy.”

Mark Henick 's highly anticipated first book, So-Called Normal: A Memoir of Family, Depression, and Resilience , will be published by HarperCollins on January 12 and is available now for presale at dozens of major chains and online booksellers worldwide.

Excerpt from So-Called Normal: A Memoir of Family, Depression, and Resilience by Mark Henick ©2020. Published by HarperCollins Publishers Ltd. All rights reserved.

Mark Henick is the author of So-Called Normal: A Memoir of Family, Depression, and Resilience.

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Psych Wards: The Good, The Bad, and The Misunderstood

When you hear the term ‘psych ward,’ what images come to mind?

Is it a place of healing and support, or does it bring to mind scenes from movies filled with dramatic and often harmful misrepresentations?

The Online Mental Health Review Team is uniquely qualified to delve into psychiatric patients and wards due to their comprehensive knowledge and experience in mental health and practical experience with online psychiatry platforms and mental health services.

In today’s post, we’re looking to shed some light on what psych wards are, debunk some common misconceptions about psychiatric units, and explore their role in mental health care.

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What Are Psych Wards?

Psychiatric wards, often known as psych wards, are hospital departments where individuals with mental health conditions are treated. They provide a safe environment and facility for patients with severe mental illnesses requiring immediate attention and care.

Contrary to popular belief, psych wards are not intended to be places of punishment or confinement. Instead, they aim to provide necessary psychiatric treatment and stabilization, helping individuals regain control of their lives.

The Good: Benefits of Psych Wards

Psych wards offer a range of resources and therapeutic options to assist individuals in managing their mental health issues. Here are some of the key benefits:

• Variety of Therapies : Psych wards offer different types of therapy, such as cognitive-behavioral therapy, group therapy, family therapy, and art therapy tailored to each individual’s needs.
• Supportive Environment : They provide a supportive and compassionate environment where individuals can focus solely on their recovery without the distractions and stresses of daily life.
• Professional Staff : Psych wards are staffed by trained mental health professionals who can provide immediate care and treatment.
• Safety : For those experiencing severe mental health crises, psych wards can provide a safe, monitored environment to prevent harm to themselves or others.

What are the cons of a mental hospital?

Understanding the potential drawbacks of various mental health hospitals and hospitals is essential to making informed decisions about your care.

• Potential for Trauma : In some cases, the experience of being in a mental hospital can be traumatic, often due to feelings of isolation or lack of control.
• Stigma : A societal stigma associated with psychiatric hospitalization can lead to self-esteem issues and social isolation.
• Cost : Mental hospitals can be expensive, and not all insurance plans cover the full cost of treatment.
• Limited Privacy : Inpatient treatment often involves shared spaces, which can limit privacy and personal space.
• Disruption of Daily Routine : Being in a mental hospital can disrupt regular routines and responsibilities, such as work, school, or family commitments.
• Depersonalization : Some patients feel depersonalized due to the institutional nature of mental hospitals.

The Bad: Misconceptions and Misrepresentations

Comment by from discussion in mentalhealth

Despite these benefits, psych wards often have a negative reputation. This is mainly due to misinformation, stigma, and their depiction in media. Movies and TV shows often portray psych wards as places of horror and mistreatment of patients, which is far from reality.

Historically, there has been poor care and abuse in community mental health institutions. These unfortunate events led to widespread institutionalization and a negative perception of these facilities. However, it’s important to note that these do not reflect modern psychiatric care (for the most part, but there are severe downsides to modern care as well).

The Change: Improved Care and Advocacy

Over the years, policy, procedures, and strong advocacy changes have significantly improved the care provided in psych wards and private hospitals. Increased regulations, patient rights, and a greater understanding of mental health have all contributed to these advancements.

Moreover, advocacy groups, doctors, and individuals sharing their personal experiences have played a significant role in debunking myths and reducing the stigma associated with psych wards.

What happens in a mental hospital?

• Intake Process : Upon arrival , patients undergo an intake process, including providing medical history and current symptoms.
• Evaluation : A treatment team of mental health professionals conducts a comprehensive review to determine the best course of treatment.
• Personalized Treatment Plan : Each patient receives a customized treatment plan, encompassing therapy, medication, and other appropriate interventions.
• Therapy Sessions : Patients participate in various forms of therapy, including individual, group, and family therapy sessions.
• Medication Management : Regular reviews and adjustments are made to ensure its effectiveness and manage any side effects.
• Safety Measures : To ensure patient safety, certain restrictions are in place, such as no door handles to prevent self-harm.
• Discharge Planning : Before leaving, a discharge plan includes follow-up appointments and ongoing treatment recommendations.

What are the negative outcomes of psychiatric hospitalization?

Let’s delve into some potential negative outcomes of psychiatric hospitalization to help you make informed decisions about your care.

• Potential for Rehospitalization : Some individuals may experience a revolving door phenomenon, where they are repeatedly admitted and discharged, which can be distressing and disruptive.
• Post-Hospital Syndrome : This refers to a period of vulnerability after discharge where patients may experience health issues unrelated to the reason for hospitalization.
• Stigma and Discrimination : Patients can face stigma and discrimination from society, and even friends and family, post-hospitalization.
• Strained Relationships : The hospitalization process can place significant stress on personal relationships , which may lead to tension or estrangement.
• Employment Challenges : Returning to work after hospitalization can be difficult due to workplace stigma or employment gaps.
• Financial Strain : The cost of hospitalization can lead to financial difficulties, especially if the individual cannot work during their stay.

Does the psych ward cause trauma?

While psychiatric wards provide critical care for many, it’s essential to understand that these environments can sometimes contribute to trauma.

Here’s an exploration of how and why this can occur:

• Involuntary Hospitalization : Involuntary commitment to a psych ward can be a traumatic experience, often due to feelings of loss of control or freedom.
• Hierarchy of Patients : Some patients may suffer from the perception of being labeled as a ‘good’ or ‘bad’ patient, creating additional stress.
• Interaction with Staff and Other Patients : Negative experiences with staff or other patients can contribute to trauma during a stay in a psych ward.
• Intensifying Pre-existing Difficulties : Psych wards can sometimes exacerbate pre-existing mental health issues, adding to the overall trauma.
• Fear and Emotional Instability : The intimidating atmosphere of psychiatric facilities can cause anxiety and long-term emotional instability.

What is the dark side of a psychiatric hospital?

As we strive to shed light on our mental illness and health awareness, it’s equally important to acknowledge and understand the darker aspects of psychiatric hospitals that are often hidden from public view.

• Overcrowding: Some psychiatric hospitals suffer from overcrowding, leading to increased patient stress and reduced quality of care.
• Stigma and Discrimination: Patients in psychiatric hospitals often face stigma and discrimination, both within the hospital and from the outside world.
• Inadequate Staff Training: Some hospitals may not provide sufficient training for their staff, leading to poor patient care and potential mishandling of crises.
• Lack of Personal Freedom: Patients can experience a loss of personal freedom and autonomy due to restrictive hospital policies.
• Medication Overuse: Over-reliance on medication as the primary form of treatment can lead to side effects and overlook the importance of outpatient therapy and holistic approaches.
• Seclusion and Restraint Practices: These controversial practices are still used in some institutions and can traumatize patients.
• Inadequate Aftercare: Discharge planning and aftercare services are often insufficient, leaving patients vulnerable once they leave the hospital.

Why are there no handles in psych wards?

The design of a psychiatric ward often seems unusual to outsiders, but every detail, including the lack of door handles, is purposefully designed with patient safety in mind.

• Suicide Prevention: The absence of door handles is a crucial measure to prevent suicide attempts, as handles can be used to tie objects.
• Anti-Ligature Hardware: Psychiatric wards use anti-ligature hardware, including door fixtures, to minimize self-harm risks.
• Standard Precautions: Just like hooks on walls or hand sanitizer dispensers, door knobs and handles are often excluded to prevent potential misuse.
• Clothing Restrictions: Similar to why patients are asked to remove laces and belts, door handles are eliminated to reduce self-harm opportunities.
• Hang-Proof Design: Many psychiatric hospitals and wards have hang-proof knobs and fixtures that cannot be used for hanging.
• Criticism of Institutional Feel: Some critics argue that such measures contribute to a prison-like environment in psychiatric wards.

What is head banging in psych wards?

Headbanging in psychiatric wards is a severe behavioral concern that requires understanding and empathetic intervention.

• Self-Harm Behavior: Head banging is often a form of self-harm, where patients may hit their heads against walls or other hard surfaces to cope with emotional distress.
• Coping Mechanism: For some, it can serve as a coping mechanism, physically expressing internal pain or frustration.
• Attention-Seeking: Sometimes, head banging can be an attention-seeking behavior, signaling that the individual needs help or intervention.
• Communication Tool: Sometimes, it may be a non-verbal way of communicating emotional distress or unmet needs.
• Symptom of a Disorder: Head banging can also be a symptom of various mental health disorders, including autism spectrum disorder, self-injurious behavior (SIB), and others.
• Response to Medication: Sometimes, it may be a side effect or reaction to certain medications.

Is it wrong that I want to go to a psych ward?

The desire to seek help in a psychiatric facility or ward is not inherently evil; it’s a sign that you recognize a need for professional mental health support, a crucial step toward healing.

• Acknowledging the Need for Help: Wanting to go to a psych ward indicates that you understand the severity of your situation and are willing to seek professional help.
• Safety and Supervision: Psychiatric wards provide a safe environment with constant supervision.

Are Psych Wards Bad? Conclusion

Psych wards are an essential part of our mental health care system. While they have had their share of challenges, their role in providing immediate, professional help for individuals in crisis cannot be understated.

It’s time to move past the misconceptions and acknowledge their vital role in many people’s journey to recovery.

You may learn more about psych wards through our articles covering costs , rehab , costs with insurance , patients , grippy socks , and psych ward memes .

Finally, we’d appreciate your thoughts! Suggest a  mental health software  you think the  Online Mental Health Reviews platform  should  review  next.  Our team  would love to hear about your experience!

If your organization is considering a mental health tool, please email us to request a review. If appropriate, we will secret shop the service your organization wants to learn more about and leave a comprehensive review.

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If You Are In Crisis

If you find yourself in a mental health crisis, seeking immediate help is crucial – waiting for an online therapy session may not be sufficient. If there’s a risk of harm to yourself or others, please dial 911 without delay. Should you be battling suicidal thoughts or of self-harm, the Suicide and Crisis Lifeline is available around the clock at 988, ready to provide support.

You may want to try virtual urgent care via  Sesame Care  or  DrHouse  for non-emergency but still urgent situations.

Additionally, the Substance Abuse and Mental Health Services Administration (SAMHSA) operates a free, confidential helpline at 800-662-HELP (4357), offering information about treatment options for mental health and substance abuse disorders 24/7, every day of the year.

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Trapped in a Psych Ward: ‘I felt kidnapped.’ Another patient comes forward after 7 investigation into MI doc

(WXYZ) — The 7 Investigators were the first to show you in February how patients have been alleging they were held against their will in psychiatric hospitals, or they say they were coerced into staying for treatment they don’t need. Since then, we’ve received hundreds of calls and emails from patients and family members with similar stories.

VIDEO: Watch the original investigation from February below:

Officials with Michigan’s Department of Licensing and Regulatory Affairs (LARA) say they can’t comment on on-going investigations, but the 7 Investigators have learned that more complaints have been filed with LARA about the psychiatrist in our story.

Being held in a psych ward comes with an almost a total loss of freedom: in many cases, you cannot leave the locked hospital unit until a psychiatrist says you can.

And now another local patient has come forward to share her story of how she says she was held against her will.

Sarah Guarino cherishes her freedom and her life after being locked in a psychiatric hospital in March.

“I felt kidnapped,” said Guarino.

The 31-year-old from Royal Oak says she suffers from Post Traumatic Stress Disorder and insomnia.

Guarino says a breakup, nearly losing her job, and intense fear she would be homeless led her to consider committing suicide in March.

“I was having what I would call a panic attack that lasted for quite a while. I didn't sleep for a couple days,” said Guarino.

Recognizing she needed help, early in the morning of March 13, Guarino called 911.

Royal Oak police took her to a crisis intake center where she met with mental health professionals. Once she finally got some sleep there, Guarino says she felt better.

“I kept asking, how long am I going to be held? They said maybe two or three days. And I said, ‘that's too long,’” said Guarino. “’I don't know if anybody's at home with my dog. I need to go back home!’”

But Guarino says she was then transferred to StoneCrest Center psychiatric hospital in Detroit.

“I was called out of the room where I was sleeping and told to get onto a stretcher,” said Guarino. “I’m agitated and confused. I am asking questions like, ‘what the hell is going on?’ And I basically got told, ‘you can stop asking questions and calm down, or you can get doped up and made to calm down and stop asking questions.’”

At StoneCrest Center, Guarino’s records show she was under the care of Dr. Nagy Kheir.

The psychiatrist works at StoneCrest, Harbor Oaks, and until last spring, he was Pontiac General Hospital’s Chief Psychiatrist.

In February, the 7 Investigators showed you how patients alleged Dr. Kheir held them in the hospital longer than necessary to bill their insurance or their Medicaid. Dr. Kheir denies that he does that.

“Patients don’t need to be in there that long if there can be another plan of care found for them outside a psychiatric hospital,” Bethany Atwell, a certified trauma therapist, told the 7 investigators in February.

We also showed you how Dr. Kheir pre-signed blank court forms called clinical certificates that are used in the civil commitment process. The forms are signed under the penalty of perjury, and sources told the 7 Investigators – medical residents were the ones filling out the forms signed by Dr. Kheir. We even found Dr. Kheir driving at the same time he supposedly was filling out one of those clinical certificates.

For the first investigation, the 7 Investigators caught up with Dr. Kheir at his new clinic in Warren.

“You’re pre-signing clinical certificates,” I said.

“Yes,” said Dr. Kheir.

“Before patients are examined,” I said.

“Yes,” said Kheir.

“Doesn’t that violate their rights,” I asked.

“Not uh, we examine them, but I sign it to be ready for the time factor,” said Dr. Kheir.

VIDEO: Watch Dr. Kheir speak with 7 Investigator Heather Catallo:

Guarino says she only met with Dr. Kheir for a few minutes on a telehealth call at the beginning of her stay at StoneCrest.

“And it wasn't even a full interview. It was just him. ‘Are you depressed? No. I'd like to go home.’ ‘Do you have suicidal ideations? No. I got some sleep, and I'm fine now. OK, cool. Thank you,’” recounted Guarino.

But Guarino says she was not allowed to go home. According to her records – StoneCrest planned to keep her for more than 3 weeks.

Guarino was in a panic to get out – her dog Enzo was home alone without food or water. She says her regular psychologist even asked Dr. Kheir to release Guarino to his care but was ignored.

“It's unprofessional. It's disrespectful,” said Guarino.

Even though Guarino signed in to StoneCrest as a formal voluntary patient – she says was not allowed to leave.

“I brought it up with the doctor every day: ‘Am I being discharged?’” she said.

Guarino also says she asked for a lawyer, but wasn’t given one.

Simon Zagata is the Director of Community and Institutional Rights for Disability Rights Michigan, a federally funded nonprofit that’s designated to investigate abuse and protect people’s rights.

Zagata says if you’re a voluntary patient and you ask for an “Intent to Terminate Mental Health Treatment” form, the facility has to release you.

“They could let you go that hour. But in the very least, 72 hours – they either have to let you go or start that court process,” said Zagata.

Guarino said it was hard to get the form.

“I asked the doctor for it, she said if I did that, they were going to open up a court case,” said Guarino.

A court case means making you an involuntary patient – where a judge could order you to stay 30 days or more for treatment.

On Guarino’s fifth day at StoneCrest, she called me. She’d been told about my first story on Dr. Kheir and the mental health system. After that phone call, all of a sudden, Guarino was cleared for discharge.

“The moment they knew that I was talking to you, suddenly I was well enough to go home,” said Guarino.

“You’re no longer suicidal?” I asked.

“Yeah, which I'd been telling them since I got there. But I was given all sorts of credibility the moment they knew I was talking to you,” she said.

Guarino added, “Suddenly, this threat of investigation made them go ‘oh no, no, no, no, no, no, no, no, she's not sick. She's not sick. She can go home.’ They wanted nothing to do with me after that.”

Days of her records indicated that she looked “bizarre” and she had “psychosis.” The day after we spoke, Guarino’s StoneCrest records show: “The patient is reporting improved mood” and “the patient was evaluated by Dr. Nagy Kheir, the patient is stable…”

While Dr. Kheir said he could not discuss an individual patient’s case due to privacy concerns – I previously asked him about the allegations that he holds patients longer than necessary.

“Are you holding patients against their will?” I asked.

“No. I cannot do that,” said Dr. Kheir.

“I’m not eager to keep patients, I’m not this guy at all,” he said.

Guarino is grateful to be back home with her dog – but now she says she’s furious her insurance was billed $16,200 for six days of in-patient treatment she did not want.

“I no longer trust medical professionals to have my well-being at heart,” said Guarino.

“How badly do you want the system to change?” I asked.

“Very badly. It needs to. This is a complete misfire. I understand that there's laws in place that were enacted to initiate greater protections for people … but the way that it's being used by health care professionals is abusive,” said Guarino.

The CEO of StoneCrest Center sent us a written statement that says:

“StoneCrest places the care, safety, and privacy of our patients as our highest priorities. While we cannot address specific circumstances, our staff follows rigorous state regulations, treatment timelines, and evidence-based clinical protocols when evaluating progress and ensuring patients are safely discharged to their next level of care.”

Meanwhile, once again, in the past Dr. Kheir has denied the allegations he holds patients to increase his billings, but he did not comment on this story.

WHAT CAN YOU DO IF THIS HAPPENS TO YOU?

This issue of voluntary vs. involuntary admission keeps coming up in almost all of the calls I’m getting from the community.

That’s why next Tuesday on May 14, 2024 at 7:30 p.m., 7 News Detroit is going to be streaming a virtual roundtable about your rights in a psychiatric hospital on our website and across our digital platforms. The roundtable is being put on by Disability Rights Michigan and the Mental Health Association in Michigan.

We want to know your questions, so we can answer them live during the stream. Please email me at [email protected] .

Resources for those who may need help:

• Mental Health Association in Michigan
• Oakland Community Health Network
• Detroit Wayne Integrated Health Network
• Disability Rights Michigan

 To file a complaint with LARA, click here.

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Psychiatric Hospitalization for Teens

When It's Needed and What to Expect

Amy Morin, LCSW, is a psychotherapist and international bestselling author. Her books, including "13 Things Mentally Strong People Don't Do," have been translated into more than 40 languages. Her TEDx talk,  "The Secret of Becoming Mentally Strong," is one of the most viewed talks of all time.

Aron Janssen, MD is board certified in child, adolescent, and adult psychiatry and is the vice chair of child and adolescent psychiatry Northwestern University.

Tetra Images/Getty Images 

• When It's Needed
• What to Expect

If your child is having suicidal thoughts, contact the  National Suicide Prevention Lifeline  at  988  for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our  National Helpline Database .

A mental hospital for teens provides the highest level of treatment available and is intended for the short-term stabilization of serious mental health issues . An inpatient setting also provides a secure environment with constant clinical supervision to ensure the teen's safety. 

Learn when psychiatric hospitalization may be needed for adolescents and what treatment looks like within these settings. It's also important to know what to expect when the teen is discharged and how you can support their mental health once they return home.

When Is Teen Psychiatric Hospitalization Needed?

While some teenage mental health issues can be treated outpatient, others might need immediate inpatient care. A mental hospital for teens may be needed if:

• The teen is at risk of harming themselves or others.
• The teen has thoughts of suicide or is engaging in suicidal behaviors.
• The teen isn't eating, bathing, or otherwise taking care of themselves.
• The teen can't sleep, sleeps a lot, or feels tired all the time.
• The teen is having psychotic episodes.

Similar to how traditional hospitals treat physical health issues, psychiatric hospitals treat mental health issues. Staff are prepared to deal with mood or behavioral changes that come on suddenly. Teen psychiatric hospitals also provide the intense structure and intervention needed to keep adolescents safe.

Teens require different treatment from adults, so it's important for teens to have access to mental health ​staff trained in dealing with younger patients.

What to Expect With Teen Psychiatric Hospitalization

The two most important things to know about psychiatric hospitalization are:

•  The treatment is fast-paced and intense.
•  The length of stay will be very short, usually for several days.

Mental hospitals for teens are intended to thoroughly evaluate the crisis, act quickly to stabilize the patient, and develop a plan for continued care. This process begins the moment the teen arrives.

Evaluation and Assessment

A comprehensive evaluation begins at the time the teen is admitted. It is completed by interviewing the teen, family members, and any mental health or school professionals who have worked with the teen and can provide relevant information. 

This assessment considers the teen's history of issues concerning mood or behavior, use of drugs or alcohol, previous treatment, physical illness or symptoms, and family history of mental illness .

Some teens may engage in psychological testing as a part of the evaluation process.

Teen psychiatric hospitals use a treatment team approach with an extensive staff of professionally trained personnel. Team members may include psychiatrists or psychologists , substance abuse counselors , therapists, social workers, nurses, activity therapists, teachers, and more.

Professionals from each discipline make recommendations for treatment both in the hospital and after discharge. While in the hospital, teens participate in numerous daily structured activities that may include:

• Academic programs to help keep up with school
• Family therapy focused on immediate concerns and next steps
• Group therapy with other hospitalized teens
• Individual therapy
• Multifamily group therapy (many hospitals suggest families continue in these groups as part of aftercare)
• Occupational, recreational, and art therapies  

Discharge Planning

Once the reasons for the crisis are identified and a teen is considered stable by the treating psychiatrist and hospital staff, a case manager will work on the discharge plan. Discharge planning refers to specific plans made for the aftercare or follow-up treatment the teen will participate in upon leaving the psychiatric hospital.

Follow-up programs will be recommended based on how well the teen responds to treatment in the hospital.

Some teens may require residential treatment after discharge, while others may benefit from day treatment. If medication and efforts at stabilization create significant changes, a lower level of care such as an alternative school or intensive outpatient therapy may be appropriate.  

A case manager works with parents on setting up aftercare services. Referrals to a therapist, psychiatrist, or other service provider will be made. Usually, a case manager will set up follow-up appointments to ensure that the teen remains healthy once they're discharged home.

Returning Home

Sometimes, parents feel like the teen is being rushed out of the hospital. They fear the teen hasn't recovered enough or they worry that safety issues aren't completely resolved.

Unfortunately, short stays are the reality of psychiatric hospitals. They are expensive to operate and are intended to assess the teen, stabilize the crisis , and provide expertise in helping transition the teen into a less intensive mental health treatment program.

That's why it's important to make sure you have a clear understanding of your teen's discharge instructions. Following up with the suggested ongoing service providers can help keep your teen mentally healthy both short- and long-term.

University of Utah Huntsman Mental Health Institute. When to seek inpatient mental health treatment at a hospital .

Pérez-García M, Sempere-Pérez J, Rodado-Martínez JV, Pina López D, Llor-Esteban B, Jiménez-Barbero JA. Effectiveness of multifamily therapy for adolescent disruptive behavior in a public institution: A randomized clinical trial . Child Youth Serv Rev . 2020;117:105289. doi:10.1016/j.childyouth.2020.105289

By Amy Morin, LCSW Amy Morin, LCSW, is a psychotherapist and international bestselling author. Her books, including "13 Things Mentally Strong People Don't Do," have been translated into more than 40 languages. Her TEDx talk,  "The Secret of Becoming Mentally Strong," is one of the most viewed talks of all time.