How It Works: Hospitalization for Mental Health

When people have mental health problems that are serious enough that they need to be hospitalized, those people and their families might find the process confusing or frightening.

To demystify what happens when inpatient psychiatric care is needed, we talked to UNC Health psychiatrist Kenan Penaskovic, MD, director of inpatient psychiatry services at UNC Medical Center. He offers insight on what patients and their families face during a crisis.

1. Care typically starts in the emergency room.

When someone is having a mental health crisis, often a family member or law enforcement officer will take the person to an emergency department. UNC Health emergency departments have trained psychiatric teams to evaluate patients with mental and behavioral problems.

Tragically, mental health units across the country are facing a lack of available beds, which means many patients wait days or even weeks in emergency departments.

“One of the hardest parts of being admitted (for psychiatric treatment) is the wait coming through the ER,” Dr. Penaskovic says. “At any time, there are an average of between 15 and 30 people in the UNC ER waiting for a psychiatric bed.”

Despite these challenges, it’s important to seek help when someone is in crisis.

2. The situation improves on the mental health unit.

“Once patients get up to the (mental health) floor, we can start working with them,” Dr. Penaskovic says. “All the units are locked so they can’t walk out of the hospital, but they are able to mingle with their peers, attend groups, eat in the day room and see their medical team every day.”

At UNC Health, the psychiatry floors are generally divided by diagnosis or age.

Mental illness is not one disease. Many diagnoses could require hospitalization. UNC Medical Center has separate units that treat:

  • Children and adolescents (ages 5-12)
  • Adolescents (ages 13-18)
  • Perinatal patients (pregnant women or new mothers)
  • Acute crises (suicidal or substance use issues)
  • Psychotic disorders (including schizophrenia and bipolar disorder)
  • Eating disorders
  • Geropsychiatry (usually patients age 60 and older)

UNC’s WakeBrook behavioral health facility has two general adult units in Raleigh.

3. Admission can be voluntary or involuntary.

Some patients realize that they need help and voluntarily allow themselves to be admitted. If someone else, usually a loved one or a law enforcement officer, is concerned by a person’s words or actions that he or she poses a danger to him or herself or others, they can petition to bring someone in involuntarily for evaluation and potential admission.

The majority of admissions for mental health disorders are involuntary, Dr. Penaskovic says. All mental health patients are evaluated by clinicians before being either released or admitted to the hospital. The second evaluator must be a physician (generally a psychiatrist).

If patients who are in the hospital involuntarily contest the involuntary admission, they can bring their cases before a judge. For example, commitment hearings are held every Friday at UNC Medical Center.

4. Treatment is focused on stabilization and safety.

Each patient is assigned a medical team that works with them daily to provide counseling, medication and other services to help stabilize their condition.

A top priority in the psychiatric units is keeping patients safe. Staff members check on patients at least every 15 minutes around-the-clock.

“Everyone is screened when they come in to make sure they aren’t carrying anything that could hurt them or someone else,” Dr. Penaskovic says.

The average stay depends on a patient’s diagnosis and response to treatment. Sometimes that is a matter of days, and other times it may be weeks or months.

Patients who need to be hospitalized for longer periods usually are admitted to one of the state’s facilities for mental health treatment.

“It’s not a quick fix,” Dr. Penaskovic says. “Our goal is to get people back in the least restrictive environment where they can safely participate in the outpatient care that they need.”

5. Families should feel empowered to speak up.

Because of federal privacy laws, a patient’s doctor and care team are not allowed to give out information about the patient, including diagnosis and treatment plans, unless the patient has given express permission. However, family members can volunteer information that might help the patient’s medical team provide better treatment. That could be information about the person’s behavior, substance use, family history or anything else that might be relevant. Unlike physical diseases, there’s no blood test or imaging scan for diagnosing mental illness. The more information doctors have, the better able they are to effectively treat someone.

“We strongly encourage family members to tell the medical team what’s going on,” Dr. Penaskovic says. “That can be really helpful.”

6. Loved ones are encouraged to visit.

Dr. Penaskovic encourages families to visit during hospital visiting hours. If you can’t get to the hospital, staff may be able to arrange a virtual visit.

“A lot of people don’t know what to say,” Dr. Penaskovic says. “Just be a sounding board. Hear them out. Encourage them to work with their medical team. Remember that you, as their loved one, don’t have to solve all the problems they tell you about.”

Also, you can advocate for your loved one with his or her medical team. “If you feel like they aren’t communicating everything they’re experiencing, ask to speak with a member of the team. Talk with their doctor.”

Most gifts and supplies are welcome. Check with the nursing staff to see what items are approved. Books, magazines and most clothing are fine. Generally, food items are not permitted.

Having someone you love in the hospital for mental health treatment can be stressful. Remember to take care of yourself while the medical team is caring for the patient. Your mental and physical health is important, too.

If you are concerned about the mental health of someone in your life, or your own, talk to your doctor or find one near you.