My Experience Navigating a Crisis and Accepting More Care

Going to the hospital for your mental health can be scary. But over the years, I’ve learned about my options, what to expect, and how important it is to get the help I need.

Nobody plans on being admitted to a mental health facility, and I can tell you stories about all the hours I’ve spent pacing through hospital lobbies, wondering if I really belonged there. And, of course, it’s important to note that no two mental health crises look the same. However, sometimes the hospital has been the best place for me to get the help I need, so it’s important to know your options when things get really difficult.

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Knowing when I need more help

When I lost my ability to sit through AP English and algebra, the social worker at my high school suggested that I check into a child/adolescent psychiatric unit where I could get more intensive treatment. She was concerned about my self-destructive behavior and extreme anxiety. I felt so desperate that I frequently begged my mother to drive me to the closest hospital that was contracted with my health insurance.

I was scared of the fact that my depression was pursuing me so intensely and worried that I would never be “normal” again. My friends tried to drag me to the school cafeteria at lunchtime, but I would rather sit with the social worker. And my chemistry teacher was always telling me that I seemed “miserable.”

All these years later, now that I am in my late 30s, I have survived many bipolar crises and have been hospitalized for both manic and depressive episodes that may have destroyed me on the outside. I can almost always tell when I am starting to slip and that I might need to pursue a higher level of care, such as inpatient hospitalization or an intensive outpatient program.

I have been seeing the same psychiatrist for the last 5 years, and when I tell him that I can hear the warning bells ringing, he knows that we need to have a serious discussion about what to do next. My doctor does not like admitting me to the hospital unless it’s absolutely necessary, and on many occasions, he has worked with me to develop a crisis plan that will keep me functioning at a basic level.

Not knowing when I need more help

I’ve learned that sometimes, even though I do know my warning signs so well, other people can tell when I am accelerating into mania or descending into depression before I do.

When I was in college, I went to a meeting for a student organization, thinking that nobody would notice that I was a little revved. I was a bit concerned about the speed of my thoughts and the fact that I couldn’t sit still in my chair at a table in the Student Union. My friends were very worried about me, though. Two of them had seen me floridly manic at the beginning of the school year and knew that when I started talking super fast and laughing hysterically about serious things, I might need some extra help.

It was a cold night at the very end of November, when Thanksgiving was bleeding into that time I was growing panicked about my final exams. My friends offered to drive me back to my apartment so I could avoid freezing on the long walk home. Thinking I was fine, I accepted their offer. But before long, they drove right past my apartment and started driving me over to that familiar place I usually tried to avoid: the psychiatric emergency room at University Hospital.

At first, the hospital staffers thought that they were only making me worse. But soon enough, I was trying to tear off my plastic hospital bracelet with my teeth. I was pacing in circles throughout the ER, ducking my head in and out of all the consultation rooms because I just couldn’t sit still. As I continued to tear magazines to bits and pieces, everyone knew that my mania was intensifying.

I was angry with my “friends” for a while, especially when the doctors changed their tune and decided to admit me to the hospital. As I angrily swallowed a tablet of Seroquel, I tried to convince them that I would be OK: I would see my own psychiatrist at his office early the next morning. But after being brought up in a wheelchair to the inpatient psych ward and rocking back and forth on my hospital bed for a while, I realized that they could possibly be right. I was certainly not in control of my mood.

My mother is another person who can notice my mood swings, even when I’m all the way in a different state and we are only talking on the phone. Over the years, she has tried to keep me out of the hospital whenever she can. But she does know that when it’s time for a medication change, I need to reach out to my psychiatrist for some extra help.

Warning signs of a crisis

You may be wondering how you can even know whether or not you are experiencing a mental health crisis and, more specifically, what you should do about it.

Severe depression with suicidal thoughts is a major indication that you need a higher level of care. Because medications and psychiatric treatments are so helpful and effective, you shouldn’t allow yourself to suffer for very long. Higher level care can help you find the right medication, dose, or treatment. And after some time on the right medication, you might feel a lot better and more in control of your life.

Other indications that you may need more help include an inability to function. Are you having a hard time getting out of bed or brushing your teeth? If you can’t make it to work or school or attend to your daily obligations, that might be a sign that you are in need of more intensive care.

Accepting higher level care

Unfortunately, hospital treatment can be expensive, especially if you don’t have medical insurance. But your life is the very most important thing, and it’s important to do what it takes to stay safe. If the doctors think that you need to check into the hospital, they are often speaking from years of experience. They have gone to medical school and completed psychiatric training and can identify a mental health crisis from a mile away.

Spending a few days in the hospital can be the best way to accelerate your recovery because the doctors and nurses are constantly observing your reactions to the medications. And these psychiatric potions can be adjusted throughout your stay if you start to experience side effects. Doctors can also come up with a preliminary diagnosis and devise an outpatient treatment plan that will work for you.

I was petrified the first time I was admitted to a hospital: the locked doors, unbreakable glass, and the other patients all freaked me out. But I know now that when I am manic or depressed, there is no safer place for me to be.

What to expect in the ER

While I may be a pro, I do realize that the emergency room can be a scary place for someone who is unfamiliar with the procedure. Almost always, if you do present to the ER in a mental health crisis, the triage nurse will take you back to the treatment zone immediately, where you will usually meet with an ER doctor first. They will run blood and urine tests to ensure that there is not a medical or drug-related reason for your psychiatric emergency.

After changing into a hospital gown, you may spend some time waiting for a psychiatric consult to decide what to do next. This can be a psychiatrist, social worker, or another sort of counselor who will talk to you about your thoughts and feelings and come up with a recommendation for your treatment plan.

In many cases, hospitals will allow a friend or family member to stay with you. When I was in college, my friends regularly accompanied me to the ER. Even though they spent the night sleeping upright in very uncomfortable chairs while I couldn’t stop moving, I felt better. If you would feel more comfortable with a loved one staying with you, don’t be afraid to ask the hospital staff. There’s no doubt that a hospital emergency department can be a lonely place, and it can also help to have someone there to help advocate for you.

The hospital can also be helpful if you are not in treatment with a psychiatrist or another mental health professional. In some areas, it is extremely difficult to get an appointment for a psychiatric evaluation and treatment. But if you are admitted to an inpatient psych unit, you can often move to the top of the list to get an appointment once you are discharged from the hospital.

If you can’t come into the hospital, or this doesn’t sound like the best option for you, there are other forms of higher level care worth mentioning.

A spectrum of options

There’s no doubt that a mental health crisis can interrupt your life. And one of your most important goals will be to minimize this as much as possible. Luckily, there is a wide range of resources, from crafting a crisis plan with your own therapist or psychiatrist all the way to an inpatient hospitalization.

For example, you might want to consider a partial hospital program (PHP), where you spend the entire day at the hospital, going to groups and activities, but come home at night to sleep. This is a cheaper option that still offers the level of intensive care that you might need.

And as I mentioned earlier, there are also intensive outpatient programs, where you will spend more time going to groups, but not as much as a PHP or inpatient program.

You won’t have to make these decisions alone: There will always be mental health professionals to provide recommendations and guide you through the process. This is simply what they do all day, every day.

Not everyone who is depressed will need a higher level of care, but it is reassuring to have that safety net in case you are in a crisis. Hospital emergency rooms are open 24/7, so they will always be available if you are suffering or just don’t know what to do next. Medication adjustments can often make all the difference.

The bottom line

Everyone’s experience is different, of course. But it’s important to underscore that help is always available to you. If you are feeling unsafe or having thoughts about harming yourself, it’s essential that you do reach out immediately for help.

I know that it can be very scary to present to an ER and tell the person at the front desk that you need psychiatric help, but millions of people do it every day. I can say that they will know what to do to assist you in the moment and help you move on with your life.