Depression: When is it necessary to get hospitalised?

Published 27 May 2024 • By Somya Pokharna

Depression comes with persistent feelings of sadness, hopelessness, and a lack of interest in activities once enjoyed, and it can significantly impair an individual's daily life. While many people with depression respond well to outpatient treatment, such as therapy and medication, there are cases where the severity of the condition necessitates hospitalisation to ensure the safety and well-being of the individual.

So, in which cases is hospitalisation necessary to treat depression? What are the criteria and procedure for admission into inpatient care? What benefits can it offer?

Dive into this article to discover!

Depression: When is it necessary to get hospitalised?

In 2022, approximately 16% (or 1 in 6) of adults in the UK experienced moderate to severe depressive symptoms, and 61% of adults with mental health conditions did not receive treatment.

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.

Behavioural 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. 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.

In the UK, "sectioning" refers to the process under the Mental Health Act 1983 (amended in 2007) whereby individuals can be legally detained and treated in a psychiatric hospital against their will. This measure is taken when a person is deemed to have a mental disorder of a nature or degree that warrants hospital treatment for their own health or safety, or for the protection of others. There are various sections under the Act that dictate the conditions and duration of detention. For example, Section 2 allows for detention for up to 28 days for assessment and treatment, while Section 3 permits detention for treatment for up to six months, renewable. The decision to section an individual typically involves approved mental health professionals (AMHPs) and at least two doctors, one of whom must be specially qualified. The process includes safeguards such as the right to appeal and regular reviews to ensure that the individual's rights are protected while receiving the necessary care.

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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