What a psychiatric hospital stay is like

Many people picture locked rooms and constant drama. In reality, most programs look more like a conference or an indoor camp, with added medical care and safety rules.

Other patients are ordinary people going through a hard time. Their reasons for being there are private, just like yours.

• Being at serious risk of harming yourself or someone else
• Needing close observation to understand what is going on
• Symptoms becoming so intense that daily life has stopped working
• Not being safe at home right now, even with support

After a stay, people usually step down to less intensive care, such as an intensive outpatient program, counseling or a residential program. The guide “Levels of care & kinds of help” explains each step.

The emergency team may recommend involuntary inpatient care, voluntary inpatient care or outpatient care with a referral. Many people go home with a plan instead of being admitted.

If the emergency department’s hospital has no psychiatric unit, or no open beds, staff arrange transport to another facility. This can take time.

A voluntary stay is for someone who is at risk but willing to get help. Voluntary patients usually keep the right to ask to leave, though exactly how depends on the state.

An involuntary stay may happen when someone is at serious risk of harming themselves or others. Trained professionals make this decision, not family members, although family can share information.

States put time limits on emergency holds, most often 72 hours. Keeping someone longer without their agreement goes through a separate legal process that differs by state.

In some states, a hospital can keep a voluntary patient for a few days after a written request to leave while it decides. In others, patients can leave at any time unless the team finds they are at serious risk.

If the team believes you are at serious risk, your status may be changed to involuntary if your state’s criteria are met.

Every patient has rights, whatever their legal status. See “Your rights in hospital” below, and ask staff for a written copy of your rights and your state’s rules.

• A consent form for treatment
• A list of people allowed to call you
• A list of people allowed to know you are there
• A patient bill of rights
• The hospital’s privacy policy

If you have a psychiatric advance directive or a health care proxy, share it now.

Staff check your belongings and may do a body search in a private area. Items that aren’t allowed on the unit are stored safely and returned when you leave.

A staff member asks about why you came, your health history and any alcohol or drug use. It can be long. You can ask for a break or a glass of water.

A psychiatrist, psychiatric nurse practitioner or physician assistant usually leads your care and meets you once a day. A nurse or social worker may join. Treatment decisions are made here, so it helps to go.

Groups usually teach skills, like reframing unhelpful thoughts or setting boundaries. You usually don’t have to share personal stories.

Some units have only short free periods, while others plan recreational activities. Art supplies, board games, books and puzzles are common. TV rules vary.

Staff do frequent checks, including overnight. Someone at very high risk may have a staff member with them at all times. Showers are usually private, in a locked area.

Meals are usually served on the unit, with options for special diets. Where you can wear your own clothes, laundry is usually available.

Rules on phones, tablets and laptops vary. Call the unit to ask, along with questions about grooming items and medical equipment like a CPAP machine or walker.

You, or your representative, must be told your rights before care begins whenever possible. You should receive a written patient bill of rights at admission.

You have the right to take part in making your care plan, to be informed about your health and to be involved in treatment decisions.

You can make an advance directive, and staff must follow it as the law allows.

You can ask for a family member, representative or your own doctor to be told promptly that you were admitted.

Hospitals must have written visiting policies. You can choose your visitors and change your mind at any time. Visits can’t be denied because of race, religion, sex, disability or other protected traits.

Psychiatric units often limit how many people can visit at once and set visiting hours.

You have the right to personal privacy, care in a safe setting, and freedom from abuse or harassment. Your records must be kept confidential, and you can ask to see them.

Restraint or seclusion can never be used to force, punish or retaliate, or for staff convenience. It may be used only to keep someone physically safe in the moment, and must end as soon as possible.

Most patients never experience it. Public data on each hospital’s rates are listed on Medicare’s Care Compare website.

Hospitals must tell you who to contact with a complaint, resolve it promptly and give you a written decision.

Each state has a Protection and Advocacy (P&A) system that investigates abuse, neglect and rights violations for people with serious mental illness..

• Get a few nights of steady sleep
• Learn one coping skill in group
• Make a plan for the first week home
• Understand what led up to the crisis
• Line up support for after discharge

• How will we know I’m ready to go home?
• What is my legal status, and what does it mean?
• What kind of care will I have after I leave?
• What is the plan for today?
• Who can I talk to if I disagree with a decision?

Discharge is considered once the acute crisis has passed and you can manage safely without 24-hour nursing. Next steps may include an intensive outpatient program, counseling or residential treatment.

The person leading your care writes the discharge order, and your nurse and social worker sign off. The guide “Life after a psychiatric hospital stay” covers what comes next.

At admission, patients choose who may call them and who may be told they are there. If staff can’t confirm anything, it may be because of these choices and privacy rules.

You can still share helpful information with the care team, such as what you noticed before the crisis.

• Bring allowed clothes and books (check the rules first)
• Feed pets or water plants
• Help with a message to an employer or school, if asked
• Keep the mail and bills safe
• Tidy their home before they return

• “I’m glad you’re getting help.”
• “I’m here, whatever you need.”
• “You don’t have to talk about it.”
• “We’ll figure out home together.”

The guides “When someone you love is in hospital” and “Looking after yourself while supporting someone” have more.