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Hospitalization gets a bad rap — sometimes for a good reason — but sometimes it can be helpful during a severe episode of mania or bipolar depression.
Key Takeaways
- In-patient psychiatric care provides short-term safety and stabilization when severe bipolar symptoms make staying at home unsafe.
- A clear discharge plan that includes therapy, peer support, and medication management can ease the transition home.
- Gradually returning to work and daily responsibilities can reduce stress and support continued stability.
- If someone is in severe distress, experiencing psychosis, or having thoughts of self-harm, seek emergency or crisis support immediately.
The phrase “for your own good” is usually attached to something you know you’re not going to like — such as ending up in the hospital because of an episode of severe bipolar depression or mania.
But the fact is, there may be times when your current safety and future well-being benefit from a hospital stay — even if the hospital isn’t where you want to be or what you think you need.
“It can get scary,” admits Megan C., a musician from Massachusetts who has bipolar 1 disorder. “You’re not thinking clearly, and you can feel like you’re losing a lot of your freedoms — and in some ways you are,” explains Megan. “Big decisions are being made for you. But having people around who you can trust and who can advocate for you is essential.”
Not every facility will offer state-of-the-art care. Some interventions can be traumatizing, such as physical restraints or a medication regimen that you haven’t consented to. Nonetheless, a hospital stay can give you the space you need to start getting well — a break from everyday stresses and an opportunity to get concentrated attention from professionals dedicated to pulling you back from the brink.
Unlike a hospitalization for a physical illness like pneumonia, getting in-patient care for a mood episode can stir up difficult emotions: shame, self-blame, and embarrassment. Yet, mood disorders, including bipolar disorder, and psychosis spectrum conditions among people ages 18 to 44, account for nearly 600,000 hospitalizations in the United States each year, according to the National Alliance on Mental Illness (NAMI).
It often takes a shift in perspective to view going to the hospital in a positive light rather than as a disgrace or personal failing.
“Being proud doesn’t make you stronger, it just makes you avoid getting help and means you suffer longer,” notes Andrew B. Klafter, MD, a psychiatrist in Cincinnati.
Voluntary vs. Involuntary Psychiatric Hospitalization for Bipolar: What Patients and Families Should Know
Megan says she has experienced seven or eight hospitalizations over a five-year period. The ones where she was an active participant in the treatment process were easier to get through, she recalls.
Participating as much as possible in your care tends to improve the outcome, no matter how you’re admitted (involuntarily or voluntarily with your consent), where you are admitted (whether in a locked ward in the community hospital or a plush private facility), and how long you stay (from 24-hour crisis care to in-patient treatment spanning several months).
An older study using data from 106 American hospitals found the average length of a psychiatric hospitalization was 7 to 13 days.
Perhaps because of exaggerated portrayals in movies and on TV — and sometimes from real-life stories — some people view psychiatric hospitalization as an extreme measure, almost like a punishment. But the opposite is more often true: It’s a form of protection.
“For me, it was necessary to seek additional help because I felt unsafe on my own and couldn’t guarantee my safety,” says J.K. of Illinois, who was hospitalized once for suicidal ideation and a second time while experiencing hallucinations. “Anyone who is in a similar situation should not feel ashamed to ask for help outside of their regular care team, family, and friends.”
When a psychiatrist recommends hospitalization, it’s usually intended as a short-term intervention to resolve an acute situation. Longer-term stays may be necessary depending on the situation, says Sue K. DiGiovanni, MD, associate chair for clinical services in the psychiatry department at the University of Rochester Medical Center (URMC) in Rochester, New York.
“We try to keep the hospitalization as brief as possible,” notes Dr. DiGiovanni, “yet long enough so that an individual’s symptoms can stabilize and we have time to work with them, their families or significant others, and others involved in their treatment on an out-patient basis to come up with the best possible discharge plan.”
At a teaching hospital like URMC, a treatment team might include a psychiatrist, social worker, nurses, nurse practitioners, psychiatry residents, and, at times, a nutritionist and a chaplain. The team coordinates on fine-tuning medications in order to rein in the mood episode and on developing the all-important discharge plan that will follow you home.
Daily visits with the psychiatrist can be brief, from 10 minutes to half an hour. DiGiovanni says people may mistakenly expect to receive intensive individual psychotherapy, but an acute hospital ward is not the setting for that.
Rather, the goal is to calm the crisis and have individuals exit the hospital with a blueprint for getting “connected to the out-patient resources they need,” she says.
During Megan’s last hospitalization, it took more than six months to reach a point where she was well enough to leave. At her discharge, she was worried about being assigned to a different support system than the team of professionals she’d worked with for four years.
However, the current arrangement has proved extremely beneficial, she says. She was connected to a program run by the Massachusetts Department of Mental Health that helps adults with mental health conditions set and work toward meaningful life goals.
Megan meets once a week with a clinician to talk about anything from managing her symptoms and relationships to applying for benefits and deciding whether to return to school. She also meets weekly with a peer specialist. The appointments regularly fill her with optimism and hope.
“I’ve gone nearly a year without being hospitalized,” she says. “For me, that’s a good run.”
What Triggers Hospitalization for Bipolar: Early Warning Signs and When Inpatient Care Is Needed
There’s no denying that being on a locked hospital unit can feel like a terrifying loss of control. That can be compounded by lack of insight during hypomania or mania — meaning you can’t see why you need help in the first place — and psychotic features that make it difficult to stay grounded in reality.
Jesse L., who has bipolar 1 and anxiety disorders, recalls that he hadn’t slept for several days before he landed in a psychiatric unit.
“I was pretty much out of my mind with confusion and minor delusions, so I was afraid,” the Nebraska resident says. “But I wanted to go someplace where I could be safe until I got healthy again.”
At first, the loss of his own clothes and knowing that other people were in charge of him intensified his manic paranoia. To calm his fears, he would focus on a pedestrian bridge visible from his window and remind himself that he would cross it once he was released.
Short visits with the doctor were the highlight of his stay because “he paid attention to what was happening to me,” Jesse says.
Having to be hospitalized can be doubly difficult if you have negative feelings from a previous experience — perhaps from feeling that certain treatments were imposed on you or because of how staff treated you.
“If that’s you, don’t be ashamed of it,” says Rebecca Christofferson, a registered clinical counselor in private practice in British Columbia. “You are a survivor.”
A movement known as “trauma-informed care” recognizes the effects of feeling powerless when receiving mental health treatment. Christofferson suggests alerting the facility about any past trauma or negative experiences.
Conflicts may arise even with the most sensitive care team, such as when a person argues they are ready to go home but the doctor disagrees.
“When that happens, for the individual, it feels like, ‘You’re not listening to me. You don’t want to help me,” explains DiGiovanni. “But there are times I have to go against what they’re saying they want because, in my professional opinion and in my good conscience, I can’t just let them go without having the kind of support they need to be successful once they return to the community.”
What Happens After Discharge From a Psychiatric Hospital: Recovery, Follow-Up Care, and Relapse Prevention
Stephen T., who lives in the Toronto area, appreciates hospitalization as a dedicated break to work out the kinks in a new bipolar medication regimen.
“That’s probably the best place in the world you can try it. You’re monitored. You’re not at your job or in the real world. You can speak directly to the staff about how you’re feeling, and judge for yourself whether it’s working,” says Stephen.
Medications can take anywhere from a couple of days to a few weeks to reach full effect, so patience is critical.
Stephen notes that in addition to the formal treatment, connecting with peers who are in the same boat can provide both important support and a source of satisfaction.
“You begin to form relationships,” he says. “You’re as much helping them as they are helping you.”
Stephen’s advice is drawn from three hospitalizations over seven years. Ending up in the hospital again, especially after a decent stretch of stability, can trigger feelings of hopelessness and frustration. Yet Stephen prefers to view his repeat visits as part of the learning curve in managing his bipolar 1 disorder.
He’s gone more than a decade without a return of symptoms severe enough to warrant re-admittance.
“My close friends and family who know my personal history are proud of me, considering where I’ve been and where I am now — with a great career, a loving wife, and a young daughter,” he says.
The Post-Hospitalization Phase in Bipolar Disorder
Getting released from the hospital typically doesn’t mean you’re completely well. Basically, you’re stabilized enough to work on getting yourself healthy again, much like starting rehab after a heart attack.
It’s important to continue treatment — either with doctors and therapists in the community or through partial hospitalization, which is an intensive out-patient day program — and to rely on your support network, and to apply yourself to self-care strategies.
It’s also important not to jump right back into your usual routine as soon as you’re out. Trying to re-adjust too quickly could undo the progress you made during your hospital stay.
If you have a job, asking for shorter hours or fewer responsibilities as you transition back will make long-term success more likely. It may be tempting to prove you can operate at your previous level or even do more than usual, especially if work piled up while you were gone, but it’s unrealistic to expect that from yourself right away.
“Understand that you’re recovering, and you’re not going to be at 100 percent capacity the first week,” says Dr. Klafter. “Maybe you’re at 75 percent, but that’s better than zero percent, which is what you would’ve been the week before.”
It’s worth addressing any lingering negative feelings about your hospitalization in therapy or through peer support. Feeling reluctant to go back when you need to could put your health at risk.
“If you get to the point where you feel like you’re at risk of harming yourself or somebody else, always go to the hospital,” says Jennifer Gerlach, a mental health clinician in Illinois, adding: “Your life is more important than that.”
If you or a loved one is experiencing significant distress or having thoughts about suicide and need support, call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24-7. If you need immediate help, call 911.
Editorial Sources and Fact-Checking
UPDATED: Printed as “A Safe Space,” Summer 2017