What Happens When You Voluntarily Commit Yourself?
If you're here because you are considering voluntarily committing yourself, then let me just say that I am so terribly sorry that you are having such a tough time. However, as cliché as it sounds, realizing you need help is the first step to feeling better. Hospitalization seems like a scary, drastic measure, but it has saved the lives of thousands of people—myself included.
Unfortunately (or maybe fortunately!), my experiences with hospitalization have only occurred within the state of Illinois. I would assume that the process is similar in other states, but I think this disclaimer is worth mentioning. Additionally, I am not a healthcare professional. This is based solely on my own experiences, and I cannot guarantee that my experiences will be the same or even similar to yours. For the best advice, please speak with your primary doctor, a psychiatrist, or a counselor.
SUICIDE HOTLINE: 1-800-273-8255
Will I be involuntarily hospitalized if I tell my primary doctor, psychiatrist, or counselor that I feel suicidal/manic/etc.?
When I began my journey of seeking treatment for my mental illness, a big question I had was, "If I tell my doctor, psychiatrist, or counselor about my symptoms (in my case, suicidal ideation), will I be involuntarily committed?"
In my experience, the answer is no.
Once again, in my experience, the immediate response of those helping treat my illness wasn't to whisk me away to the hospital. This very well could be because I have bipolar disorder, and suicidal ideation is a very common symptom that can be managed using outpatient treatment. For example, when I have told my psychiatrist that I have had thoughts of wanting to hurt myself, he takes that as a sign that my medication needs to be adjusted or changed. When I tell my counselor, she does remind me that inpatient treatment is an option but also works with me to find the source of what's bothering me and helps me find coping mechanisms.
Ultimately, though, it is up to the healthcare professional and their assessment of how safe you are. I have built relationships with my counselor and psychiatrist, and I believe that they trust me to go to the hospital when I know my symptoms are no longer manageable. However, if they believed I was an immediate danger to myself or others, they may consider involuntarily hospitalizing me.
If you want to simply have a conversation about something like suicidal ideation with your healthcare providers, I would suggest letting them know that despite feeling poorly, you have a safety plan. A safety plan is a plan for when you start to feel overwhelmed and maybe as though you want to hurt yourself. This could be that you go over to your parent's house; you tell your spouse how you're feeling; you call the suicide hotline; you remove everything from your home that you could have hurt yourself with. The plan is to keep you safe.
Having a safety plan may prove that you are not an immediate danger, and it could allow you to get outpatient treatment without feeling as though you're going to be punished and locked away for simply seeking help.
How do I know when I need to go to the ER/hospital?
Major signs are:
- Thoughts of hurting yourself
- Thoughts of hurting others
- Feeling as though you cannot function or perform daily duties (e.g. lying in bed all day, not showering, not eating, calling into work, not caring for your family)
- Mania and/or psychosis (e.g. hearing voices, hallucinating, not sleeping)
Often times, major life events can bring people to hospitals. This includes deaths, divorces, and break ups. My first hospitalization was because I was triggered by a breakup. Whatever the reason, don't be embarrassed or feel that it's not important enough. If you feel that you are unsafe, unstable, or unable to preform in your daily life, then a hospital stay may be something to consider.
What should I bring to the ER/hospital?
You should bring an ID and your insurance information. I would also suggest that you bring a list of any numbers you need (family, friends, job) if you don't have them programmed into your phone. All hospitals are willing to let you grab a number off of your phone, but it helps if you already have the numbers you need ready to go. Also, make sure you know the name of your primary doctor, counselor, and psychiatrist (if you have one) so that follow-up appointments can be scheduled for when you get out of the hospital. Lastly, to pass the time, you may want to bring someone with you to the ER.
In terms of clothes, I try to keep it to the bare minimum. Behavioral health units will provide all bed linen, pillows, and towels. Some hospitals even have washers and dryers so that you can wash your personal clothes. Additionally, most hospitals provide you with scrubs or hospital gowns in the case you don't have clothes that you can wear. Toiletries will also be provided. Nonetheless, here's what I bring to the hospital.
- 3 comfortable shirts
- 3 comfortable pairs of pants (no strings)
- 1 sweater (it gets really cold in hospitals!)
- 3-5 pairs of socks
- 3-5 pairs of underwear
Toiletries provided by the hospital:
- Shampoo/conditioner (I typically have to bring my own shampoo/conditioner because I have ethnic hair)
- Deodorant (hospital deodorant is the worst!)
- Body wash
- Lotion (not the best stuff)
- Comb, and sometimes, a brush (I would highly recommend you bring your own hairbrush—just make sure it's plastic and not metal)
- Toothbrush and toothpaste
- Feminine products (can bring your own)
Things that aren't allowed:
- Headbands (hair elastics should be okay as long as they're in your hair the whole time)
- Lotions with pumps (has to be squeeze bottle)
- Hair gel (or other products with alcohol)
- Mouthwash (with alcohol)
- Strings on clothing
- Sometimes bras (some will allow bras with underwire, some will ask if you want to take the underwire out of the bra—I personally choose not to wear a bra or wear one that doesn't have underwire to the hospital)
Now, let me warn you. Not all hospitals allow you to wear your own clothes or use your own toiletries. I had one hospital that wanted its patients to only use things the hospital provided (their toiletries and clothing) for safety reasons. In this hospital, I had to fight to use my hairbrush (I have crazy thick hair) because they only provided a comb, and they me told my plastic brush was dangerous... no? But I stayed persistent—yet respectful—and won the battle. Once you enter a hospital, it's quite a culture shock, and you immediately feel the loss of power. If you have a personal product that you desperately need, such as hairbrush to manage thick tangled hair, just remember you catch more bees with honey! The nurses and doctors are there to help you feel better. If there is a personal item that would help you feel more comfortable during this process, I'm sure they'd be willing to help.
What happens at the ER?
The ER is usually the first stop in the journey of voluntary hospitalization. For the sake of this example, I will assume that you have not tried to hurt yourself (overdosing, cutting wrists, etc.).
What to tell the nurses/techs at the ER desk?
You can tell them whatever you feel comfortable with. You can be as vague or blunt as you like, but I would try to keep it concise. Trust me, you will have plenty of opportunities to explain what's going with you throughout the hospitalization experience.
You can tell the nurse/tech at the desk that you have been suffering from depression/mania/hallucinations. You can tell them that you're suicidal. Or you can simply tell them that you're mentally ill. Personally, I usually just say that I'm bipolar and suffering from a depressive episode.
I'm not sure about other hospitals, but the hospital I go to, I'm usually admitted very quickly. I say my final goodbyes to my loved ones via text—I usually go by myself to the hospital—before I go to the ER or while I'm in the waiting room. Once a tech takes you back into the ER, you have to change into a gown (while the tech watches you—for your safety). Your clothes, cell phone (don't forget to turn your phone off!), and other belongings are locked into a locker.
Then you're taken back to a room. Because the admission is for psychiatric reasons, you're put under a suicide watch. There is almost nothing in the room other than a bed, bedside table, and a chair. There isn't a TV, so if you want to bring a loved one with you to pass the time, it may be a good idea. There may be a camera in your room to watch you for safety reasons.
At this point, you meet the ER nurse who will care for you. In my experience, the nurses have always been very kind.
The nurse will ask you what's going on and why you're there. You will be asked if you have made any plans to harm yourself, have tried to harm yourself recently or in the past. Be honest. It can be very hard to open up and to explain what you're going through, but in order to get the help you need, it's imperative that you be honest.
The nurse will also ask you a lot of general health questions, and then tell you that you will meet with the doctor soon and the crisis team will be called (I'll explain the crisis team later).
Before meeting with the doctor, a series of tests will be performed. You will have to do a urine test, blood test, and EKG. These tests are done to make sure you're healthy. Sometimes vitamin deficiencies or an out of whack thyroid can be the source of many issues regarding mental illness. Plus, it can take a long time for the crisis team to show up, so the tests are something to pass the time.
Once the tests are done, the doctor shows up. Once again, you have to explain what you're experiencing to the doctor, going into all the gory details. The doctor kind of does the same thing the nurse does. The doctor is there for less than ten minutes, he does a quick exam and lets you know that the crisis team will be called.
The Crisis Team
After the doctor leaves, it's a pretty long wait for the crisis team. I tend to go to the ER at night that way I can sleep instead of sitting in the room bored. Last time I went I think it took 3-4 hours for the crisis team to show up from the time the doctor left.
Once the crisis team gets there (which is a bit a misnomer because it happens to be a single social worker), they will also ask you to go into the gory details about why you came to the ER. The social worker takes notes while you spill your heart out. Then when you're done, they will ask you if you feel safe enough to go home. So, if you are in the ER and start to have second thoughts about committing yourself, this is your time to bail. However, if the ER doctor doesn't believe that you're safe, they may try to involuntarily commit you. This doesn't seem likely, but it's something to keep in mind.
Assuming that you don't feel safe, you can tell the social worker that you want to be committed. If you have a preference of where you would like to be hospitalized, let the social worker know. They will call those places first to look for empty beds. If you don't have a preference, they will start looking at the closest hospitals and expand outward based on distance.
If your preferred places are filled, you can choose to go home. However, like I said, the doctor could still involuntarily commit you. I feel like this is very unlikely, but it's possible.
How do I get to the behavioral health unit from the ER?
Assuming you are placed into a hospital of your choosing, the nurse and or crisis social worker will let you know. A few hours later, a nurse may come by to have you sign paperwork agreeing that you have voluntarily committed yourself.
If you are going to a different facility for your hospitalization, you will need to be transported. This can be by ambulance or by a vehicle such as a van. The nurse will grab your belongings from your ER locker, and you'll be loaded up into a vehicle (or wheeled to the floor that the behavioral health unit is on if you're staying at the hospital).
The two times that I was transported, the EMTs let me use my phone, and I was able to text my loved ones during the ride. This may not be the case for everyone, but I would ask! You can't really be a danger to anyone with a cell phone while you're in an ambulance.
What happens when I get to the unit?
Depending on the facility, you may be greeted by a nurse or a social worker as soon as you arrive on the unit. Regardless of who greets you, the first thing that happens is paperwork. Lots of paperwork. You are going to be overwhelmed by your surroundings (and feel exposed because chances are that you're still in a hospital gown with your butt hanging out), but try to pay attention. A big portion of what they go over with you is your patient rights. Unfortunately, I have been in some not-so-great places that don't always stick to those rights.
What are my rights as a patient?
Some of these rights in the state of Illinois include:
- Right to refuse treatment/medication (if you don't like the way something makes you feel, you don't have to take it)
- Right to have access to your toiletries when you ask (some hospitals let you keep your toiletries in your room, others keep them behind the nurses' station--even in this case, if you ask for your toothbrush, legally, they have to give it to you)
- Right to request discharge (usually a form that you can fill out) within the next five days (excluding weekends and holidays). This doesn't mean you can leave immediately, but it means they can't hold you any longer than five days from the time you fill out the paperwork. Unfortunately, the doctor can file a court petition to keep you in the facility, and they can hold you in the facility while waiting for the trail. However, I feel like this is unlikely unless you are a very large danger to yourself or others
You will also sign a form consenting to allow them to either sedate you or physically restrain you if you become agitated and seem to be a danger to yourself or others. I've never come across this problem myself. I've only seen it happen once during my three hospitalizations and it was because a person was a danger to themselves.
Here is some more information about patients' rights in Illinois.
What is the first day on the unit like?
The very first day on the unit is usually very chill. You spend quite a bit of time with the nurses. They will ask you about what brought you to the hospital (again) and go over your medical history with you. The nurses will also take inventory of your belongings, and then give you clothes (may be your own clothes or scrubs) to change into. You're also given your toiletries (hospital provided and possibly your own belongings once inventory is done) and towels to shower with. You may be given menus to fill out for your meals.
After the shower, I usually take a nap. The nurses are pretty understanding about this. Not only is it difficult to sleep in an ER, but some people come in during manic episodes where they haven't sleep in days.
At some point you will meet with your psychiatrist. Bigger units (or depending on if it's weekend) may have several psychiatrists as a part of their staff. Smaller units may only have one.
The psychiatrist will want to know everything about you. They will ask you about your symptoms and even your family's history of mental illness. They do this in order to give you an accurate diagnosis. An accurate diagnosis means more effective treatment. Often times, your treatment will include medication. You may ask for information about your medication to help decide if you want to take it. Also, as stated earlier, you may refuse medication if you don't feel comfortable taking it.
What are the other patients like?
They are just like you and I! A lot of them are dealing with life stresses or mental illness symptoms. I think the other patients make the experience a lot more enjoyable. I really recommend that you talk and share with the other patients because they may have experienced what you're going through and may be able to offer advice or give you a better perspective on your situation. Most of the patients I've met have been genuinely kind-hearted people that I was able to share a lot of laughs with during a very difficult time in my life.
What is daily life like on the unit?
Daily life on the unit is very structured during the week.
Usually, beginning around 6 am to 8 am, they allow patients to shower.
8 am to 9 am is usually breakfast time and a time that they allow you to use phones.
After this, there are usually "groups" or "classes" one after another. Some of these groups/classes may include:
- Group therapy
- Medication education
- Spiritual group
- Nutrition group
- Recreational therapy
The groups aren't always fun, but they're meant to help you, so it's important that you attend and participate. Additionally, attendance is taken in the groups. The more you participate, the more likely you are to get discharged.
In two of the three hospitals I've been in, it was not mandatory to attend groups. It was encouraged but not required. However, one that I went to, the patients were locked out of their rooms and were forced to attend groups.
Around 11-12pm, lunch is served (also a time in which you can use the phones), and the groups will resume around 1 pm.
Usually, around 3 pm, the nurses switch shifts and the patients are sent to their rooms during this time until the switch is made.
After dinner at 5 pm, patients usually have free time. During free time patients use the phone, watch TV, color, play board game, or walk up and down the halls for exercise.
The hospitals I've been in won't force you to go to bed, but at 11 pm they usually make you turn the TV off.
Weekends tend to be less structured. There are fewer groups and more free time.
Is one on one therapy available?
Yes. Although it is much easier to achieve this in smaller facilities, the psychiatrist is there for you. Plus, anything you tell the psychiatrist will help render a more accurate diagnosis.
In addition to the psychiatrist, there will be social workers and therapists on staff that are there to help you and listen to you.
Lastly, although the nurses aren't licensed as therapists, they too are there to listen and to help you.
Another piece of information that may be helpful to some people, family therapy sessions are available. You just have to ask your psychiatrist.
Can people come visit me?
Yes! Most hospitals have visiting hours every day, usually in the evening (e.g. 5-7pm). Sometimes they do have age restricts. For example, no one under the age of 12 can be on the unit—but not all have this type of restriction. Sometimes there are limits on how many people can come. However, if the limit is three people, for example, most places are willing to let your visitors take turns visiting you.
When will I get released?
It really depends on the psychiatrist and what you have going on. It's usually between 3-7 days—so, 5 days is a good guess. If you are adamant about going home, it may be sooner, but it varies. If you came in on a weekend, you may have to stay longer because the weekend doesn't count during your stay.
For reference, my first hospitalization, I left on the 4th day. My second, I left on the 8th day. My most recent, I left on the 5th day.
Will there be outpatient resources available to me once I'm released?
Yes! The nurses will contact your psychiatrist and counselor if you have them. If you don't have either, the nurses will help you find a psychiatrist or counselor. They may also contact your primary doctor for health issues that are discovered during your hospitalization. They may also contact your primary instead of a psychiatrist if your situation does not require a one (e.g. you're not on medication).
They do this in order to make sure you're safe and to make sure that you're being monitored if you started a new medication.
If you don't have a stable home to return to, they will help you find a place to stay. If you need to enter a rehabilitation center, they can set that up for you as well. Anything you need, please ask for it!
Please stay safe!
I have answered all the questions that I can think of! Please let me know if you have any other questions and I would be more than happy to answer them. Please take care of yourself, and I hope that you (or your loved one if you're looking this up for someone else) find your way back to happiness!
© 2017 Alexa J Cobb