So, you’ve got a character you want to get into a mental hospital. How can you do this?
- What disorder is she suffering from?
Coming up with a diagnosis in your head is a great way to start. Most hospitalizations are for either depression or a psychosis like schizophrenia according to the CDC. They both can lead to legitimate reasons to hospitalize.
- Why does she need to be in a hospital?
Not just your story’s reason, but from a mental health perspective. Nowadays, managed care and legal guidelines have been rather specific on what warrants “medical necessity” for someone being admitted to a psych unit and staying there.
The primary reasons to hospitalize are: a) danger to self, b) danger to others, and c) severe incapacity. This last can get tricky, so I’ll address it first. Essentially it means that your character can’t take care of herself…at a very basic level like feeding, toilet, etc. Personally, given the settings I’ve worked in, I have never seen this. So, you’d be better off with either danger to self or danger to others. Without searching out the stats, my guess is that danger to self is the primary reason for a person to end up on a psych unit. For “danger to self” read “suicidal.”
Voluntary admission
Okay, so your character, let’s call her Mary, shows up at the local emergency room. She’s got some minor cuts to her wrist and looks like she’s about to cry any minute. She also probably isn’t wearing make-up and her hair may look like it hasn’t seen a brush in a while. Why’s this important? Depressed people generally don’t care about their appearance and may even feel they don’t have the energy to bother with personal grooming.
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Mary is eventually taken to a “quiet” room, a room set aside for emotionally distraught folks. This is going to be a slow process, so don’t rush it. She’s likely to wait hours before being seen by a doc who medically clears her and sets up the admission to the hospital’s psych ward. A call will have to go out the to unit’s medical director, usually a psychiatrist. The psychiatrist may or may not see her in the Emergency Department. Mary will sign the forms and let herself be admitted. Her insurance will be checked. Most insurance nowadays cover mental health issues, so this isn’t likely to be an issue.
Mary is likely to be in the hospital for about 5 days. She will be placed on medications and required to attend group therapy session and various therapies like occupational therapy (usually arts and crafts). Once the doc determines that she is no longer a danger to herself, she’ll be released and told to follow-up with an out-patient doc to manage her meds. Sometimes she is referred for therapy, but this can be hit or miss.
Involuntary admission
Now, what if Mary doesn’t go to the hospital, but her husband finds her sitting on the bed, blood oozing from several small cuts to her wrist. He encourages her to go to the hospital, but she mutely shakes her head. What does he do? He calls the paramedics. The police will also get involved. These folks have the ability to transport Mary to a facility for a 72 hour hold. During this time, Mary will be examined by two physicians who will determine if she is indeed a danger to herself and needs further hospitalization. If they do determine she needs more time, but she refuses, the she is involuntarily admitted (committed), often for about 2 weeks (at least in California). Be aware that in the US, the procedures vary by state, so be sure to check!
The bottom line with an involuntary commitment is that the hospitalization is court ordered and the patient cannot leave until the court says so.
It was my experience while in California that very few individuals sent for a 72 hour hold (we called them “5150s” based on the governing statute) were kept any longer than that.
The units where an involuntary patient is held are, in the US, run by the county and are usually very crowded and chaotic. It might be difficult to get a look inside such a unit due to confidentiality laws, but if you can swing it, do so! You certainly will get an eye-, ear- and nose-ful of sensory information for your story.
For further reading on involuntary commitment see: https://www.psychologytoday.com/blog/therapy-it-s-more-just-talk/201310/involuntary-psychiatric-hospitalization
Psychology and Writers 