Depression: When is it necessary to get hospitalized?

Nearly one in five American adults will have a diagnosable mental health condition in any given year, and in 2022, 22.5 million adults in the U.S. experienced major depression.

Severe depression, also known as major depressive disorder, manifests through various symptoms that can vary in intensity. Some key indicators are:

• Persistent sadness or depressed mood.
• Loss of interest or pleasure in most activities.
• Significant changes in weight or appetite.
• Insomnia or excessive sleeping.
• Fatigue or loss of energy.
• Feelings of worthlessness or excessive guilt.
• Difficulty concentrating or making decisions.
• Recurrent thoughts of death or suicide.

Behavioral signs of severe depression may include social withdrawal, neglect of personal hygiene, and a noticeable decline in daily functioning.

What are the benefits of getting hospitalized for depression?

Hospitalization offers several benefits for individuals with severe depression:

• Provides a safe environment where individuals are protected from self-harm and closely monitored by healthcare professionals.
• Allows for more intensive treatment approaches, including medication adjustments and various forms of therapy (individual, group, and family therapy).
• Offers a structured daily routine, environment, and support from a multidisciplinary team, which can help stabilize mood and promote recovery.

When does depression require hospitalization?

Risk of self-harm or suicide

One of the most critical criteria for hospitalization is the risk of self-harm or suicide. Statistics show that individuals with severe depression are at a significantly higher risk of attempting suicide. Warning signs include:

• Expressing thoughts of wanting to die or harm oneself.
• Seeking out means to commit suicide, such as purchasing a firearm or stockpiling pills.
• Talking about feeling hopeless or having no reason to live.

Immediate action is necessary if these signs are present, including seeking emergency medical help or contacting mental health hotlines.

Inability to perform daily activities

Severe depression can impair a person's ability to perform daily activities, such as going to work, attending school, or maintaining personal hygiene. Indicators of this level of functional impairment include:

• Chronic absenteeism from work or school.
• Inability to care for oneself or dependents.
• Neglect of basic personal hygiene and health.

In such cases, hospitalization can provide a structured environment to support recovery and ensure basic needs are met.

Psychotic symptoms

In some instances, severe depression can lead to psychotic symptoms, including hallucinations (seeing or hearing things that are not there) and delusions (false beliefs). When these symptoms are present, hospitalization is crucial to ensure the individual receives the appropriate medical treatment and is protected from potential harm.

Non-response to outpatient treatment

Hospitalization may also be necessary for individuals who do not respond to outpatient treatment. Criteria for determining treatment resistance include:

• Failure to improve after multiple trials of antidepressant medications.
• Inadequate response to different types of psychotherapy.
• Persistent and severe symptoms despite ongoing treatment efforts.

In such cases, a more intensive, inpatient approach may be required to stabilize the individual's condition. Additionally, some treatments, such as electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS), are only administered in a hospital setting and may be necessary for individuals with severe, treatment-resistant depression.

How to get admitted for inpatient treatment of depression? How can one prepare for it?

The process of hospitalization typically begins with an assessment by a mental health professional, during which, the severity of the individual's symptoms, risk factors, and overall mental state are evaluated. If hospitalization is deemed necessary, the professional will recommend admission to a psychiatric hospital or a specialized unit within a general hospital.

There are different types of hospitalization for individuals with severe depression:

• Inpatient Hospitalization: Provides 24-hour care in a hospital setting, offering intensive treatment and monitoring.
• Partial Hospitalization Programs (PHP): Offer intensive treatment during the day while allowing individuals to return home in the evenings. This option can be suitable for those who need structured support but not 24-hour care.

Sometimes patients are involuntarily hospitalized if they pose an immediate danger to themselves or others. The laws regarding hospitalization for depression differ by state, but generally, involuntary hospitalization occurs only if a person is deemed a risk to themselves or others, or if they are severely impaired and unable to care for themselves.

Preparing for hospitalization for depression involves several practical and emotional steps to ensure a smooth transition and to maximize the benefits of the inpatient treatment. Here are some key steps to take before hospitalization:

Consult with healthcare providers

Engage in a thorough discussion with your doctor, psychiatrist, or therapist about the necessity of hospitalization. Understand the reasons behind the recommendation and what to expect. If unsure, consider seeking a second opinion from another mental health professional to confirm the need for inpatient care.

Understand your treatment plan

Ask questions and inquire about the specific treatment plan, including therapies and medications that will be used during hospitalization. Also discuss the goals of hospitalization and how success will be measured. This can help set realistic expectations and focus on recovery.

Handle legal and insurance considerations

Review your insurance policy to understand what is covered under inpatient psychiatric care. Contact your insurance provider if you have any questions. Additionally, familiarize yourself with your legal rights regarding mental health treatment and hospitalization. This can include understanding the process for voluntary and involuntary admission.

The length of your stay is determined by the staff based on your clinical condition, but insurance companies can independently decide if they no longer deem continued hospitalization "medically necessary." In such cases, they may refuse to cover ongoing treatment costs. If your doctor disagrees with this decision, they will typically appeal it. If the doctors no longer believe you are in danger, you will be released within two to seven days, depending on your state's laws. If you disagree with the hospital's assessment, you can request a mental hygiene lawyer to have a judge review the need for ongoing involuntary hospitalization. Contact your state's Protection and Advocacy agency for assistance.

Under the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA), insurance companies must provide mental health coverage that is no less favorable than coverage for medical or surgical benefits, including necessary hospitalization. Some insurers require an evaluation by a contracted evaluator before approving hospitalization.

Prepare your personal affairs

Let close family members and friends know about your upcoming hospitalization. Their support can be invaluable during this time for emotional encouragement and practical help. They can provide comfort and reassurance during your stay.

Make arrangements for any responsibilities you may have, such as work, school, or caregiving duties. This can include informing your employer, arranging for pet care, or delegating household tasks.

Pack essentials

Pack comfortable clothing and personal hygiene items. Check with the hospital for any restrictions on what can be brought to ensure your safety and those of others around you. Do not forget to bring a list of current medications, dosages, and any other relevant medical information. This ensures continuity of care and helps the healthcare team understand your medical history.

Emotional preparation

Understand that hospitalization is a step towards recovery, and it may take time to see improvements. Be patient with yourself during this process. Focus on the potential benefits of hospitalization, such as access to intensive care, professional support, and a structured environment conducive to healing.

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