When Hospitalization Is Needed for Depression

Medically Reviewed by Smitha Bhandari, MD on November 28, 2022
5 min read

Most depression -- over 90% -- is treated on an outpatient basis. But, in cases of severe depression or treatment-resistant depression, some people need to stay in the hospital for a short time. You might seek hospitalization yourself. Or you could be hospitalized under a doctor's order.

There is an unfortunate stigma associated with being hospitalized. Many people feel ashamed, as if it's a sign that they are "crazy" or "weak." Some people fear that being hospitalized is the same thing as being institutionalized or sent to an asylum.

But that's not the case. Usually, a stay in the hospital is just a way for you to recover in a safe and stable environment. This allows you to take a break from some of the daily stresses that contributed to your depression. Your health care providers can work with you to try different treatments and figure out which are best.

Most people don't like being in the hospital. You may not like the routine, the food, or the other patients. It might be frightening. But look at it this way: Depression is an illness, as real and as serious as heart disease or cancer. And sometimes depression -- just like other serious diseases -- requires treatments that can only be provided in a hospital.

There are many people with depression who might benefit from a hospital stay. Here are some examples.

  • People who are at risk of hurting themselves or others. Preventing suicide and violence is the most common reason for hospitalization. A stay in the hospital allows you to get back in control.
  • People who are unable to function. Hospitalization makes sense if you are so depressed that you can't take care of yourself.
  • People who need observation when trying a new medication. Sometimes, your doctor may be fine-tuning your depression medicine and advise doing so under the close supervision of the hospital. Since you will be under constant observation there, your doctor will be able to see more easily how well a treatment is working.
  • People who need treatments that are given only in a hospital. Some treatments, like electroconvulsive therapy (ECT), are usually given in the hospital. A stay in the hospital allows you to recover from anesthesia and gives your doctors a chance to see how you're doing after treatment.

Many people with depression may need hospitalization because they feel suicidal or unable to take care of themselves day-to-day. A doctor must evaluate whether hospitalization is necessary and appropriate and whether a less intense treatment setting, such as an intensive outpatient program or partial hospital program, may be a more appropriate alternative. Sometimes patients are hospitalized against their will if they pose an immediate danger to themselves or others. The laws concerning hospitalization for depression vary from state to state. Generally, you can only be hospitalized against your wishes if you are considered to be a risk to yourself or others or are gravely impaired and unable to take care of yourself.

During an emergency, a health care professional or police officer may require you to be evaluated at a hospital. Once there, a hospital doctor will talk to you and decide whether you actually need to be hospitalized. While the doctor has the final say whether you get admitted, friends or family members can be involved by providing input about your symptoms and functioning to the health care professionals who are evaluating you. If a doctor believes that involuntary hospitalization is necessary, the hospital has the right to evaluate your condition, usually for several days, before asking a judge whether ongoing involuntary hospitalization and medications or other treatments are medically warranted and can therefore be administered against your will.

The length of your stay is determined by the staff based on your clinical condition, although insurance companies can independently decide if they no longer believe continued hospitalization is "medically necessary."  In this situation, they may refuse to pay for ongoing treatment in the hospital. If your doctor disagrees with an insurance company's decision to refuse to pay for ongoing treatment, the doctors typically will appeal their decision. If the doctors no longer think that you are in danger, you will be released within two to seven days, depending on the laws in your state. If you disagree with the hospital's assessment, you can ask to speak with a mental hygiene lawyer in order to request that a judge rule on the need for ongoing involuntary hospitalization. Talk to your state's Protection and Advocacy agency.

When in the hospital, you may face restrictions designed to keep you and other patients safe. Even if you are admitted to the hospital on a voluntary basis, you usually cannot leave whenever you want. The hospital may strictly control visits from family and friends and limit the items you can take in with you, like cell phones or laptop computers. Sharp objects like razors that you may bring with you will usually be kept by staff in a safe place, and you may be asked to not wear shoe laces or belts. You may be on a locked ward for at least some of your stay. You may also be expected to follow a certain schedule. While the restrictions can be hard to accept, keep in mind that they are in place for the safety of you and the other patients.

Some health insurance policies will cover hospitalization for a limited amount of time. Others won't cover it at all. However, under the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA), part of Obamacare, insurance companies cannot impose less favorable benefits on mental health coverage than on medical/surgical benefits, including necessary hospitalization. Before a person can be hospitalized, some insurers require that they are evaluated by an evaluator under contract with their company. Very few insurers will cover a hospital stay for depression that isn't an emergency.

While in the hospital you will usually be seen by one or more psychiatrists or a physician's assistant daily, although such one-on-one visits in the hospital tend to be brief. Formal individual psychotherapy generally doesn't occur while in the hospital, although various forms of group therapy are common, focusing on strategies such as stress management, coping with depression, and discussions about medications and their side effects.

Keep in mind that most hospital stays for depression are brief and voluntary. The goal of hospitalization is to get you on the right track by starting treatments that can be continued on an outpatient basis. When you leave the hospital you should be safe and stable and on the path to recovery.