What happens during an inpatient psychiatric stay?

Lucy Easler, RN

Behavioral Health and Psychiatry

How many people think of inpatient psychiatric treatment has unfortunately been molded by overwrought, overdramatic and often false portrayals in movies, television shows and other media.  In truth, inpatient psychiatric care, or milieu therapy, provides an intensive level of care that may be the right choice for those struggling with severe psychological distress.

What exactly happens during an inpatient psychiatric stay? Lucy Easler, RN, answered this question along with others about this little-understood form of treatment.

Why would someone need inpatient psychiatric care?

“Someone experiencing severe psychological distress may find that going inpatient is the right choice for them,” said Easler. “It’s no different than heading to the emergency room during a physical medical emergency.”

The goal of inpatient care is to help you overcome the acute psychological crisis that led to you needing that care, and to stabilize you enough to resume treatment outside of a hospital environment. The idea is not that you will be cured during inpatient care, but that you will begin to recover and heal and continue the healing process at home with ongoing outpatient care.

The most common reasons for a person to come into an inpatient care environment are:  

• Self-harming behavior  
• Suicidal intent or plan 
• Severe depression 
• Manic episodes 
• Altered mental states
• Acute psychosis, including delusions or hallucinations 
• Escalating reckless or impulsive behaviors that put you or others at imminent risk 

How do you decide if inpatient care is the right choice?

“It’s not your diagnosis that determines whether inpatient psychiatric care is right for you or your loved one,” said Easler. “The decision is based around how severe your symptoms are.”

A mental health crisis could have many causes. While mood disorders, like major depressive disorder or bipolar disorder, psychotic disorders including schizophrenia or schizoaffective disorder, or substance-induced psychosis or depression are the most common reasons someone might be admitted, there are other conditions and concerns that could require inpatient care, including:   

• Extreme physical stress  
• Severe emotional stress or trauma  
• Complications of medical conditions and illnesses
• Reactions to prescribed medications  
• Substance use and abuse

 “Inpatient psychiatric care, or milieu therapy, is usually used when individuals are at the most significant risk of harming themselves or others,” said Easler. “Suffering from these mood disorders, psychotic disorders or substance use-related disorders can make it extremely difficult for someone to care for themselves and remain safe.”

 Can you be put in inpatient psychiatric care against your will?

In some cases, someone could need emergency care but not be able to recognize that they are in the midst of a serious mental health crisis. People who do not or cannot acknowledge that they need help can be, in certain cases, involuntarily committed to treatment.

“In these cases, a family member, neighbor, health care professional or police officer can request that a specific person be admitted to inpatient psychiatric care against their will in order to protect themselves or others,” said Easler.

For someone to be admitted against their will, that person must actively be:

• In danger of harming themselves because of mental illness 
• In danger of harming other people because of mental illness
• In danger of harm from being unable to care for themselves due to mental illness

 “One example might be someone who is committed because they have a suicide plan, they have stopped caring for themselves in a way that puts them in danger or at risk or they have physically attacked someone or threatened to do so,” said Easler.

Behavior that is “bad” or “unlawful” isn’t enough to admit someone involuntarily. It needs to be due to a mental illness. If you are not sure whether you or your loved one’s symptoms are severe enough to go to the hospital, do not assume they are not! If you or someone you know is in crisis, it is critically important for you to talk to someone as quickly as possible.

 What happens during an inpatient psychiatric stay?

“Inpatient psychiatric care is not designed to be a long-term treatment,” said Easler. “Inpatient psychiatric environments are meant to include intensive, short-term treatment that help with the immediate mental health crisis, to ensure the person can safely go back to their everyday life while continuing treatment from there.”

During an inpatient psychiatric care stay, the treatment team focuses on helping patients establish healthy routines and structure around sleep, nutrition and self-care. Using group therapy, individual work and ongoing therapeutic activities like music and exercise with a consistent schedule, patients can begin to understand their symptoms and how to manage them.

 Activities like music or exercise help patients to focus on the present and soothe frayed nerves, so they can better participate in and benefit from their milieu therapy. The psychiatrist may also recommend medications, although not always. These recommendations will be based on a patient’s symptoms, history and preferences.  

“Inpatient psychiatric care and milieu therapy are sometimes necessary,” said Easler. “Like visiting the emergency room after a severe physical injury, this kind of immediate care provides intensive, focused treatment to help the patient recover faster than might otherwise be possible. In many cases, inpatient psychiatric care can save a life.”

If you or a loved one is suffering from a mental health crisis, please text or call 988, the National Mental Health Crisis and Suicide Hotline, and seek immediate care.