The majority of mental health issues are managed in the community, and even people with quite severe conditions can often be managed through a combination of high quality regular care from health professionals and putting in place home and community supports.
There are some instances however where a hospital admission may be beneficial, for example to provide extra support, to help stabilise a severe mental health condition, to learn how to better manage mental health symptoms, to commence a course of treatment, or for more intensive monitoring of personal safety. These are some indications for hospital admission you can discuss with your doctor.
In more severe cases – especially when someone is considered dangerous to themselves or others – doctors may recommend an involuntary admission. This is not considered lightly and there are many checks and balances to make sure that people’s autonomy and rights are respected. The underlying principle is that people receive the least restrictive care that is available, and so if it is at all possible to manage the person out of hospital, at home, in the family or in the community, this is always preferable.
The process of involuntary admissions varies from state to state across Australia but they all involve strict governance by a mental health act and involve the approval of a treatment order by a magistrate or tribunal, more than one doctor (including a psychiatrist) approving the admission and a scheduled review by a mental health tribunal if the admission is going to be more than three working days. More information about involuntary admissions and how they operate can be found on the SANE website.
The question arises however for some people if they might benefit from a voluntary admission, which might be suggested by the doctor or by the person themselves. In these situations, informed consent is essential, and people should fully understand the treatment plan and agree that they want to go to hospital without any pressure from anyone, and of course be aware that they can withdraw their consent at any time. Usually your regular GP or mental health professional will know the admission criteria for the local hospitals and can discuss the pros and cons.
It’s important to think carefully about what the purpose of a voluntary admission is, and your doctor and mental health professionals will discuss with you what are the aims, such as temporary extra support, commencing a new treatment, learning better skills to manage your mental-health symptoms, or temporary intensive monitoring to ensure safety. Some people find a voluntary admission a circuit breaker that helps them get a good start back on the road to recovery.
In general, a hospital admission for a mental health issue is very much considered a last resort as in reality there is some loss of privacy and autonomy, and for some it can be an unpleasant experience – for instance, you might find yourself in a room with someone else experiencing severe mental health issues. There is also the potential financial cost of a voluntary admission, and so this needs to be considered especially if considering a private hospital, which can be expensive especially if you don’t have private health insurance. Another issue to consider is the availability of local services which vary across Australia – and often have different intake criteria. People in our forums have shared different and varied experiences.
The sorts of activities that occur during a hospital admission include more intensive psychological care, such as group work led by a mental health professional, individual therapy, or commencing a new pharmacological treatment if necessary. People are often encouraged to schedule personal activities during the admissions that help them get back into a rhythm of recovery, such as hobbies, study if they are a student, or catching up with visitors such as family or friends during visiting time.
It’s important during a hospital admission to discuss with your mental health team what the plan is after you are discharged. What can be changed about the circumstances of your life that contributed to the admission in the first place? Who is going to be part of the mental health team once you are back in the community - a GP, a psychologist, a psychiatrist, or other allied health professionals? How are you going to manage stresses such as work or family duties once you get home?
Another important question is how you will manage your own safety, and your mental health team will help put in place a safety plan so that you know what to do if you are feeling at risk once you’ve been discharged. There are some excellent resources such as the Beyond Blue BeyondNow App which helps people structure a suicide prevention plan that is always with them on their phone. It’s also really important to attend scheduled follow-up appointments once you’ve been discharged. Beyond Blue’s Way Back Support Service is designed to help people who have previously attempted to harm themselves to attend follow up care after discharge.
Being admitted to hospital for a mental health issue needs to be considered carefully with your main health professional to consider the risks and benefits and its helpful to get as much information as you can so you know what to expect, and importantly to make sure that there is a good plan put in place for when you’re discharged.
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