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.

Age at interview 23

Gender Male

Age at diagnosis 19

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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 u making constant emergency visits to student counseling, who eventually told me, hey, this is not a sustainable. They recommended that I begin an intense 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 a week, which ended up having a positive effect on me. It really forced me to take stock with my life and to kind of delve into the issues of my past that have led me to this point in 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.

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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.

Age at interview 18

Gender Female

Age at diagnosis 11

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Why is it so difficult to get help? 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 watch, I didn’t want to deal with the problem at the time, I knew that I had responsibilities I had to take care of, 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 that. 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.

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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.

Age at interview 20

Gender Male

Age at diagnosis 18

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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.

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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 a lot.

Age at interview 18

Gender Female

Age at diagnosis 11

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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.

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Hospital treatment had many positive aspects for Sam: it gave him access to useful intensive therapies, and made him feel both less alone and more empathic.

Age at interview 23

Gender Male

Age at diagnosis 19

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Yeah. My first night there, I just lay on my bed in my room in complete darkness, and I recall the thought coming to me of how the hell did my life get to this point? And the rest of the week was, in large part, waiting for someone to confront the answers to that question. The scheduled therapy at the hospital was extremely intensive. It’s usually under order of six or seven hours of therapy a day from a variety of angles. There was this group therapy in which we would talk about our feelings. There was art therapy in which we would try to express them through drawing. There was psychodrama in which we would act them out, which was I was very drawn to. There was spiritual therapy, which I did not find helpful, but, yeah. But the interesting thing about being in a mental hospital is that, is you’re interacting with your fellow patients and you’re all tackling the issues that you each are dealing with. You get to know each other very well, very quickly. So, a couple of positives came out of that dynamic that I achieved with my group in the hospital. This sense of not being alone and that other people were dealing with the same kinds of issues and symptoms that I was dealing with was very helpful. This sense of increased empathy that I gained from seeing other people in situations worse than mine, people with substance addictions, people who have been living with these symptoms for longer, people who have been living with these symptoms without the resources that I began to recognize I could employ, people who had lived through more severe traumas, that might not be a helpful way of phrasing it, but people who had lived with greater complications to their own system than I had. That increased empathy that I was forced to attain from my experience with my fellow patients gave me a healthier, more balanced view of my symptoms. Just the fact that I was constantly getting perspective from my patients and from my therapist about these issues that I was really putting into words for the first time gave me the beginnings of the tools with which to analyze myself and try to improve myself thereafter. That was where I first inhabited the term “codependency”, for instance, which has been a huge help in my identifying problematic patterns of behavior and thinking that I think exacerbate depressive tendencies and learning to weed them out of my life, for example.

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