Hospitalization Health Article

Definition

Hospitalization or inpatient care is the most restrictive form of treatment for a psychiatric disorder, addictive disorder, or for someone with more than one diagnosis. Whether it is voluntary or involuntary, the patient relinquishes the freedom to move about and, once admitted, becomes subject to the rules and schedule of a treatment environment. Hospitalization is necessary in cases where an individual is in imminent danger of harming himself or others or has made a suicide attempt. Crisis stabilization, behavior modification, supervised substance abuse detoxification, and medication management are compelling reasons to consider hospitalization. Ideally, hospitalization is at one end of a comprehensive continuum of services for people needing treatment for behavioral problems. It is generally viewed as a last resort after other less restrictive forms of treatment have failed.

Purpose

In order to be admitted to a hospital, a medical doctor (in the case of mental health, most often a psychiatrist) must "admit" the patient or approve the patient's request to be admitted. Although hospitalization may be considered a drastic treatment intervention, it can be essential in keeping people safe, helping monitor and adjust medications, treating medication side effects, supervising alcohol and/or drug detoxification, and stabilizing a patient after an acute psychiatric episode.

Before an individual is hospitalized, an evaluation and a diagnosis must be made by a medical professional. This is required in order for the patient to receive maximum insurance coverage and to receive the most appropriate treatment.

Precautions

In the public mental health system, less restrictive forms of treatment other than hospitalization are strongly recommended first. In the late 1960s the patients' rights movement led to reforms governing involuntary hospitalization. Today the criteria for admission, particularly in the case of involuntary hospitalization, are extremely narrow, reflecting a strong reluctance in this country to infringe on any person's liberty. The unintended consequences of this public policy are often observed in the numbers of people with mental illnesses who are homeless. So long as they are not posing a danger to themselves or others, they are likely to remain outside the traditional treatment system.

Hospitalization has long been negatively characterized in the media, contributing to the stigma of seeking inpatient treatment, even when it is voluntary. Scenes from the 1975 movie One Flew Over the Cuckoo's Nest have defined the worst in psychiatric hospital treatment. Such conditions cannot exist long in today's more sophisticated mental health, consumer-focused environment. A reputable facility will be accredited by the Joint Commission on Accreditation of Health Care Organizations, or by a similar governing body, which usually assures a minimum level of service. Most hospitals now have a Patient Advocate, usually an attorney who is on-site daily, or accessible by phone, and whose job is to investigate complaints and protect a patient's rights. In addition, a federal law mandates that every state have a Protection and Advocacy Agency to handle complaints of abuse in hospitals. While their effectiveness varies from state to state, they can be helpful in explaining the rights of a hospitalized patient. Some states have also implemented ombudsman programs to address patient complaints and to help people negotiate the mental health system.

Treatment facilities may be locked or unlocked. A locked unit will have tighter security to protect patient privacy and to keep patients from running away. In most cases when a patient is voluntarily admitted, he or she may leave treatment at any time, invoking the right to do so against medical advice (AMA).

In the past, patients were often not part of their own treatment planning process. The rise of the patients' rights movement has led to more active patient involvement in all phases of treatment. They have the right to refuse certain forms of treatment. Most hospitals now have a clearly posted Patient's Bill of Rights and may also have a patient's council or other body to represent their interests and recommend changes to the inpatient environment.

Confidentiality is paramount in a hospital setting, so much so that hospital staff seldom acknowledge that a specific patient has been admitted. Group therapy rules generally stress the importance of keeping members and the content of group sessions confidential.