Depression is a potentially serious illness that should never be ignored. If someone you care about shows signs of clinical depression, take action to ensure they get the help they need.
You may even need to take steps to protect the patient from themselves. Depression affects everyone differently, and sometimes it’s difficult to be sure that medical intervention is necessary. As a general guideline, it’s probably better to err on the side of caution if you suspect someone you care about may become a danger to themselves.
Never dismiss talk of suicide. People who are depressed often feel hopeless and lack the perspective to realize that they can get better with proper treatment. Keep in mind that a history of attempting to commit suicide is one of the strongest indicators that a person will do so again.
Signs of Danger
Talk about suicide or open threats to commit suicide should always be taken seriously. If the threat is immediate, call for help. Call 9-1-1, the patient’s doctor, or dial the toll-free National Suicide Prevention Lifeline: 1-800-273-8255.
While you wait for help to arrive, stay with the patient. Calmly reassure them that all will be well. Remove any obvious means of causing self-harm, such as firearms or dangerous medications.
If the person hasn’t openly expressed an intention to commit suicide but you believe warning signs are present, ask direct questions: “Have you thought of committing suicide or have you taken steps to do so? Have you ever made an attempt in the past?” Warning signs may include:
- talking about wanting to end it all
- making a will or giving away personal possessions
- searching for a means of doing personal harm. Examples include researching methods of committing suicide, attempting to buy a gun, or leaving a car running in an enclosed space
- talking about feeling hopeless or having no reason to go on living
- revelations that the person is in constant pain or feels trapped
- exhibiting wild mood swings
- sleeping too much or too little
- failing to eat or eating too much, resulting in significant weight gain or weight loss that is unrelated to intentional dieting
- engaging in reckless behaviors, including new or excessive alcohol or drug consumption
- avoiding normal social contact
- expressing rage or intentions to seek revenge
- showing signs of anxiousness or agitation
When Does Hospitalization Become Necessary?
People who are severely depressed--including those with treatment-resistant depression or those believed to be an immediate threat to themselves or others--may require hospitalization. Being “committed” to a psychiatric hospital or ward sounds drastic and carries a certain lingering stigma. But, hospitalization may be the best option to guarantee the patient’s safety under certain circumstances.
Hospitalization may be necessary to monitor the patient closely when changing or adjusting medications. It may be also necessary if the patient has become incapable of caring for themselves. Severe depression that is considered treatment-resistant may prompt physicians to try alternative treatments, such as electroconvulsive therapy (ECT). ECT, newer brain stimulation techniques (such as transcranial magnetic stimulation), or vagus nerve stimulation are often effective in cases where drugs have failed. These procedures may require brief hospital stays.
The best option for hospitalization is to have the patient voluntarily commit themselves. The legal requirements for having someone involuntarily committed for psychiatric treatment or evaluation are governed by state law in the U.S. If you suspect that a loved one may need hospitalization yet they refuse, talk with a mental health professional regarding the legal requirements for commitment.
In general, thinking about suicide may not be enough to justify hospitalization. The medical expert will need to evaluate the patient to determine if they’re an immediate threat to themselves or others before agreeing to commit them to the hospital.
If a physician declines to hospitalize, yet a mental health professional without the authority to compel hospitalization still believes it’s necessary, you have two remaining options:
- persuade the patient to voluntarily commit themselves
- have the patient arrested by police and committed to the hospital
Generally, hospital stays will only last about three days (known as a "72-hour hold") unless the patient or their family can pay for a longer stay in a private facility.
What to Pack for a Hospital Stay
Hospital stays for mental illness tend to be brief due to cost. Here’s a list of some necessary items to pack
- loose-fitting and comfortable street clothes
- basic toiletries (such a toothbrush and toothpaste)
- any medications the patient is currently taking
- glasses or contacts (plus contact case and solution)
- several changes of underwear.
Don’t bring belts, razors, or shoes with laces. Anything that might be used to commit harm or suicide isn’t allowed. Basics like towels, washcloths, and soap will be provided.