Depression treatment in emergency rooms and hospitals

People with depression may seek treatment in an emergency room or hospital. This intensity of care is necessary if a person is a danger to him/herself or others or is unable to take care of him/herself safely. If you or someone you care about are suicidal or homicidal you should immediately find help.

Options are to call 911 for an assessment by Emergency Medical Services, to go the emergency room, or to call the national suicide Lifeline at 1-800-273-TALK (8255).

These resources will assess the level of risk a person has for hurting themselves or others. They also will provide resources for treatment, either immediately or in the future.

If inpatient treatment for a depressed person is recommended, it can occur in different ways. It may be given in the psychiatric ward of a hospital which also treats many other kinds of problems; in a psychiatric hospital which treats only mental illnesses; or in a residential treatment facility. Most commonly admission is voluntary, when a depressed person seeks help on his or her own.

Involuntary hospitalization can occur if a physician, mental health professional or law enforcement officer (depending on the state) determines that an individual is an immediate danger to him/herself or others but that person declines appropriate treatment. At that time an emergency “hold” can be ordered for a period that varies according to the state. After an assessment period the patient will have a hearing to determine if further commitment for treatment in the hospital is called for.

Of the young adults we interviewed, almost one in five had experiences being treated in the hospital.

Going to the emergency room or hospital

Most people we talked to were treated in hospitals because they were actively suicidal, or had attempted suicide. Elizabeth and Leanna received care only in emergency rooms when they were teenagers, and were then released to their parents. Elizabeth describes the experience of going to the emergency room after swallowing pills by saying she was “…so mad at myself for doing it, because at that point in my depression I kind of just wanted to hide, not talk, not deal with it.” Being brought to the emergency room by her parents made it much harder to keep hiding, but also led to getting better help and medications for her depression.

In the United States, admission to a hospital can be driven by the availability of beds in hospitals as well as the needs for hospitalization for any given patient. The majority of people we interviewed who went to the hospital were admitted as an inpatient, either voluntarily or involuntarily.

Sam was not looking for in-patient treatment, but found it very helpful when his outpatient program forced him to go.
Interview Transcript

Going into summer, I was on academic probation from the university. Yeah. With threat of academic suspension. I had no real structure. I had a job that I was consistently calling out of because I was not able to get myself up in the morning to go to work. Things were generally not good, and I was making constant emergency visits to student counseling, who eventually told me, hey, this is not a sustainable. They recommended that I begin an intensive outpatient program…

In retrospect, I believe that I was referred to this hospital, somewhat, disingenuously. When I checked in to ask about the intensive outpatient program, I was deemed a danger to myself and others and committed involuntary to psychiatric holding for about a week, which ended up having a net positive effect on me. It really forced me to take stock of my life and to kind of delve into the issues of my past that have led me to this point in an extremely intensive setting environment. So, while I don’t think that I needed hospitalization at that point, I do think it was a huge help.

DEP Sam
Profile Info
Age at interview: 23
Sex: M
Age at diagnosis: 19

Background: Sam works as a young professional to earn money to resume his university studies. He lives in an apartment with a roommate. He is White.

Click here to view Sam's profile page

Sierra Rose felt suicidal while she was at work, but knew she wanted to get help instead of acting on this feeling. Her mother and her boyfriend assisted her in getting to the hospital, where to her surprise they admitted her for a substantial in-patient stay.

Sierra Rose wonders why it can be so hard and expensive to get help when feeling desperate, and why there is no short-term suicide watch.
Interview Transcript

If you want help if you’re trying to get help, why is it so insanely difficult to actually get it? There’s the financial aspect of it which on its own is overwhelming. Then there’s the trying to find a provider, the insurance, the, all of the technical stuff. Why can’t I just call up a therapist or you know, walk into the hospital and be like, “I need help. Help me.” And why can’t you guys just help. It’s, I initially went into the hospital just to get on the 72 hour suicide watch, I didn’t want to deal with the problem at the time, I knew that I had responsibilities that I had to take care of, I had bills I had to pay and cats I had to take care of and it just, it wasn’t feasible at that time because of everything that goes into it emotionally. I don’t understand why it has to be made so much harder on the other side of it. There is no 72 hour suicide watch in [Place name] apparently, I didn’t know this. There is no place that you can go and be like, “I want to kill myself, I logically don’t want to, please protect me.” To be safe. And just stay there for a few days, there’s no safe haven.

To be safe.

And just stay there for a few days, there’s no safe haven.

DEP Sierra Rose
Profile Info
Age at interview: 18
Sex: F
Age at diagnosis: 11

Background: Sierra Rose lives in an apartment with her boyfriend, another roommate, and three beloved cats. She spent a week in the hospital shortly before her interview, and was continuing with out-patient care but struggling to pay for some of it. She is Italian and Jewish.

Click here to view Sierra Rose's profile page

Hospital-based treatments

People we interviewed were evenly split with respect to positive and negative experiences getting hospital treatment. Some said it was not useful or was even actively problematic: as Marty put it, “it’s not something I want to go through again, not even if I’m homeless out in a blizzard.” Ben also says he hopes never to go back, and that the presence of other people in the hospital “….means potential arguments with showers, bathrooms, and roommates and you don’t get no privacy.”

Those who benefitted from the experience included people were reluctant to go at first. Devin and Sam talked about how interacting with other depressed young adults helped them break through their isolation, build community, and gain perspective. As Devin put it, being in the hospital “helped me out,… it was nice to see that there were other kids going through the same stuff that I was going through… And they all ended up helping each other….” Other people talked about helpful intensive therapy; building specific skills to counter depression such as time management or controlling negative thoughts; or getting away from stress at home.

Colin ended up in the Intensive Care Unit after attempting suicide, and from there was admitted to the psychiatric ward for crisis stabilization. He describes this as 'the worst experience I have ever had.'

But, they kept me in the hospital just in the ICU department for a few days after that with people watching me at all times. They wouldn’t let, leave me in the room alone. And then, once I was stable enough, they sent me to the inpatient, like the psych ward part of [name]. And, I, without a doubt, that is the worst experience I have ever had. I, it’s not like the nice, like, ones that I’ve seen on episodes of like House or something where it’s like group therapy and people just come around and talk and have snacks and stuff. It was not like that. It was, it was a place of stabilization, like crisis stabilization. And, there was, I just felt so out of place. I was probably I feel like I was most definitely the only person there who was not, I mean, by my reason, not super informed of the specific conditions, but a good probably 90% of those people were schizophrenic. There was not many people there based on reality. They were all just somewhere else. And, I had to share a room with one of them. They made me share a room. I couldn’t sleep. I’m already a light sleeper as it is. I couldn’t go to bed. I was sleep deprived. I was in this room with another man in his 20s who was obviously dealing with something bigger, something that was really detaching him from reality. I was very uncomfortable. They fed us meals on schedules. There was always just screaming going on, all the doors locked.

DEP Colin
Profile Info
Age at interview: 20
Sex: M
Age at diagnosis: 18

Background: Colin works at the college he attends and lives with a roommate. He takes medications and sees a therapist. He is White.

Click here to view Colin's profile page
Sierra Rose says the hospital provided needed relief from life at home, and that both the therapy and education about depression available to her there helped her a lot. He describes this as 'the worst experience I have ever had.'
Interview Transcript

Being in the hospital, this sounds really bad but it was kind of like a vacation. I didn’t have to worry about bills, I didn’t have to worry about feeding myself, I didn’t have to worry about anything. There were groups all day long that I could go to, I could be in my bedroom, I could be in the, the you know common room. They actually, because I was no longer a suicide risk, I was voluntary, they allowed me to have my crocheting, only in the common room but I was allowed to do that. And the therapy, I went to almost every single therapy session there was available and there were sometimes 8 or 9 a day and. It’s just so much information, I think the key to truly living successfully with depression is educating yourself on it, educating yourself on what you can do to avoid going into certain moods, educate yourself on what you need to avoid and how to cope and how to deal with everything….

… the writing therapy was extremely helpful to me, it enabled me to get all of my thoughts down on paper and then you can do anything with that piece of paper, you can frame it if you love the thoughts, you can burn it if you don’t want those thoughts anymore. Writing therapy has helped immensely. And then there was the art therapy that we did, which actually got me started. I now have oil pastels and notebooks galore and I’ve been drawing a lot since I got out of the hospital. I didn’t think it would help, you know, how can drawing a tree or a flower help you feel better but it, it does. As far as the regular talk therapy I like it. When it’s done right I have to have a therapist who is willing to sit there and push me to actually reach for the answers that I am avoiding reaching.

DEP Sierra Rose
Profile Info
Age at interview: 18
Sex: F
Age at diagnosis: 11

Background: Sierra Rose lives in an apartment with her boyfriend, another roommate, and three beloved cats. She spent a week in the hospital shortly before her interview, and was continuing with out-patient care but struggling to pay for some of it. She is Italian and Jewish.

Click here to view Sierra Rose's profile page

See also ‘Therapy and counseling’, ‘Depression, medication, and treatment choices’, and ‘Depression and suicide’.

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