When Hospitalization For Depression Is Needed

Depression is more than feeling sad; it’s a label for several profound depressive disorders that can affect every facet of an individual’s life. While some people may benefit from outpatient treatments like therapy and medication, there are circumstances when hospitalization is required for the safety and well-being of the individual with depression. By understanding when and why hospitalization might be necessary for people living with severe depression, you can take steps to safeguard yourself and those you love.

Reasons someone might be hospitalized for depression

Below are a few reasons someone might be hospitalized for depression. 

Suicidal thoughts or behaviors

An immediate reason for hospitalization for depression is the emergence of suicidal thoughts, urges, or behaviors. These can manifest in several ways, including the following:

• Passive Suicidal Ideation: An individual might express a desire to die or believe that life isn’t worth living but does not have an active plan. 
• Active Suicidal Ideation: Active ideation involves specific plans to end one’s life. In this case, the person may have already procured the means to execute their plan and may have written a note to their loved ones. 
• Previous Suicide Attempts: A history of past suicide attempts significantly increases the risk of future attempts. Such a history can indicate the benefit of monitoring.

The primary concern in these cases is often safety. Hospitalization provides a safe, controlled environment where risks can be minimized. In some hospitals, clients can receive 24/7 medical and therapeutic care, and the environment is structured to prevent self-harm.

Severe functional impairment

Depression symptoms may become so severe that they impede one’s ability to engage in daily activities. Such severe functional impairment might manifest in the following ways: 

• Neglect of Personal Hygiene: Someone might stop bathing, brushing their teeth, or changing their clothes. This neglect is not out of laziness but rather an overwhelming sense of despair or lack of energy.
• Difficulty Performing Daily Tasks: Tasks like cooking, cleaning, or getting out of bed might become insurmountable challenges.
• Social Isolation: An individual might begin withdrawing from friends and family, avoiding social interactions, and staying secluded. This isolation can further exacerbate loneliness and despair.
• Work or School Dysfunction: An individual might frequently miss work or school, or when they do attend, their performance significantly drops.

When an individual’s level of functioning deteriorates to such an extent, the focus may not only be on mental well-being, as their physical health can also be at risk. They might neglect nutrition, medication, or other critical health needs. 

Hospitalization offers an environment where individuals can receive structured care, addressing their mental and physical needs. The aim is to stabilize the individual, helping them regain their functional abilities and safely return to their daily lives.

Psychotic symptoms

Depression, in its severe forms, can sometimes be accompanied by psychosis, a condition where a person may lose touch with reality. Symptoms of psychosis often include hallucinations and delusions. 

Hallucinations are sensory perceptions in the absence of external stimuli. An individual might hear voices (auditory hallucinations) that aren’t there or see what others don’t (visual hallucinations). These hallucinations can be distressing and can sometimes cause harmful actions.

Delusions are false beliefs held with firm conviction, even when presented with evidence to the contrary. For instance, a person might believe they are responsible for a catastrophic event they had no connection to or believe they possess extraordinary powers or wealth.

Hospitalization may be beneficial in these cases, as the combination of depression and psychosis can be dangerous. A structured hospital environment ensures safety, correct diagnosis, and administration of specialized treatments like antipsychotic medications. However, consult a doctor before starting, changing, or stopping any medication. 

Other harmful behaviors

Beyond suicidality, depression can sometimes manifest in other harmful behaviors like self-harm and aggression. 

Self-harm isn’t necessarily a suicide attempt. Instead, behaviors like cutting, burning, or scratching oneself can be ways some individuals cope with overwhelming emotions. However, they can pose significant risks and indicate profound distress. In addition, self-harm is a leading risk factor for future suicidal behavior. 

In addition to self-harm, some individuals may exhibit outbursts of aggression, either verbally or physically, which might be uncharacteristic of their usual behavior. This aggression could be directed toward others or inanimate objects.

Such behaviors can be a risk to the individual or those around them. Hospitalization provides a controlled setting where these behaviors can be addressed, underlying causes can be identified, and healthier coping strategies may be taught.

Ineffective outpatient treatment

Not all treatments work uniformly for everyone. In some cases, despite sincere efforts, outpatient treatments may fall short due to the following: 

• Non-Response to Treatments: Some individuals might not respond to standard therapeutic interventions or medications. Their depression may remain as severe as ever or worsen over time.
• Inconsistency in Treatment Adherence: The weight of depression can make consistent attendance to therapy sessions or regular medication intake challenging.

When traditional avenues don’t provide relief, an inpatient setting can offer more intensive, tailored, and monitored treatments. Hospitalization allows for a thorough re-evaluation of the individual’s condition, potential adjustments in medication, and the introduction of alternative therapeutic modalities.

Requiring medically assisted detox

Depression can often occur alongside substance use disorders, creating a complicated web of symptoms and challenges:

• Dual Diagnosis: Dual diagnosis refers to the co-existence of a mental health disorder (like depression) and a substance use disorder. Each can exacerbate the symptoms of the other, making treatment more complex.
• Physical Dependence: Individuals may turn to substances to self-medicate or escape the pain of depression. Over time, they can develop a physical dependence on these substances, meaning their bodies crave the substance to function normally.
• Withdrawal Symptoms: Stopping a substance suddenly can lead to withdrawal symptoms. These can range from mild (like headaches or irritability) to severe and life-threatening (like seizures or hallucinations).

In cases where depression and severe substance dependence co-exist, hospitalization is often the safest option. It provides a controlled environment for medically supervised detox. Professionals can manage withdrawal symptoms, ensure the individual’s safety, and concurrently address the underlying depression.

What are your rights regarding hospitalization for depression?

Note: The following information is not a substitute for legal advice. Reach out to an attorney or patient advocate to understand the laws in your state and county. 

Being hospitalized, especially for mental health reasons, can be an overwhelming experience. In these situations, individuals in the US have rights, including the following.  

Right to informed consent

Patients have the right to be informed about any proposed treatment, procedure, or medication. This right includes the following guidelines: 

• Medical professionals should explain treatments in understandable terms, covering the benefits, risks, and alternatives.
• Except in emergencies or specific legal situations, you can accept or refuse treatment.

To understand what situations may require involuntary hospitalization, speak to a lawyer or patient advocate for further information. 

Information rights

Your medical information is sensitive, so discussions about your health, records, treatment plans, and any therapies must remain discreet. Personal health information can’t be divulged without your permission, except in specific legally defined situations.

Right to respect and dignity

You deserve to be treated with respect, regardless of the reason for your hospitalization. When hospitalized, it may be illegal for providers and institutions to discriminate against you based on race, gender, religion, nationality, or other safeguarded identifiers. Medical staff must treat you with dignity, respect your autonomy, and be sensitive to your needs and concerns.

Right to safety

Hospitals are obligated to provide a safe environment. You have the right to be safeguarded from harm, including self-harm, while in the hospital. Restraints or seclusion should only be used as a last resort and should comply with medical standards and laws.

Right to communication

Unless medically contraindicated, you should be allowed to communicate with family, friends, or legal representatives through visits, calls, or letters.

Right to legal representation

If you feel your rights are being violated or there are legal proceedings concerning your hospitalization (like involuntary commitment), you have the right to an attorney.

Right to review your medical records

Understanding your medical situation is crucial. You may have the right to view and obtain a copy of your medical records. Some restrictions might apply, but patients generally can obtain to their sensitive information. One restriction may be therapist notes, often not divulged with clients to safeguard the therapeutic relationship. 

Right to discharge and second opinion

Unless you’re under a specific legal hold, you have the right to be discharged from the hospital. If you’re unsure about the treatment plan or diagnosis, you have the right to seek a second opinion from another medical professional.

Long-term support options 

Not everyone with depression requires or benefits from hospitalization. If you’re not in crisis, you might benefit from talking to a therapist in the long term to develop a treatment plan. However, if you face barriers to in-person therapy, online platforms like BetterHelp may be more convenient. 

One benefit of online therapy is flexibility. Breaking down geographical barriers ensures that even those in remote areas or those without easy transportation can obtain mental healthcare. The inherent flexibility of online platforms means clients can tailor therapy sessions around their schedules, potentially aiding in consistent attendance. 

With some platforms offering real-time communication, the digital approach ensures consistent support for those enduring severe depression. While online therapy benefits many people with depression, it does not replace hospitalization. However, an online therapist may be able to help you determine whether hospitalization is suitable for you. 

Research increasingly validates the efficacy of online therapy, particularly compared with traditional face-to-face sessions. Studies have found online cognitive-behavioral therapy (CBT) as effective as its conventional counterpart for depression.