Psychiatric hospitalization: What is it and who is it for?

What you need to know about the hospital's responsibilities and your rights as a patient

Aditi Surendra and Shruti Ravi

 

What is psychiatric hospitalization?

It’s when a patient is admitted into a mental health establishment for a length of time, anywhere between a few days to a few months, and provided in-patient care. Psychiatric hospitals are meant to provide a safe environment where patients can recover with the help of a structured environment and therapy.

What are the types of psychiatric hospitalization?

There are two kinds mentioned in the Mental Healthcare Act, 2017 (Act): voluntary and supported admission. The first is in the case of someone who has the capacity to make decisions about their mental healthcare and treatment. The mental health professional who is in charge will determine if the person in question has this capacity as per procedure under the Act. Where the person is admitted as an independent patient they can ask to leave the hospital at any time of their choosing and can do so without asking for consent as well. The mental health professional in charge can — for a period of 24 hours — ask the independent patient to stay in the hospital for the purpose of conducting an assessment to make sure that there is no risk of them causing themselves or anyone else bodily harm or damaging any property.

Supported admission, the second type, is when a person does not have the capacity to make a decision about their mental healthcare and treatment, or when they are a minor and a decision about their treatment is made by their legal guardian. For the period of time where a person is lacking the capacity to make their own decision, someone who has been nominated (the nominated representative) by them can make decisions on their behalf. The moment they have regained their capacity, the nominated person will no longer have the right to continue making any decisions on their behalf.

In the absence of a nominated representative, the nearest of kin can provide consent for the person to be admitted into a psychiatric hospital. Rules for reviewing capacity of the patient (section 89 (8)); maximum period of stay permitted in the hospital under supported admission (section 89 (2)); reporting to the relevant Board (section 89 (9)); and, in case of stay that extends beyond 30 days (section 90) are mentioned in the Act in Chapter XII.

Psychiatric hospitalization can also be divided according to the length of admission, kind of care and aim of the hospitalization:

This is when a patient is extremely unwell and needs urgent medical help. It is also known as an emergency admission to an acute psychiatry unit. The aim of this kind of hospitalization is to control the symptoms and ensure the safety of the patient and the people around them.

Who is it for: People with psychosis, mania, severe depression, depression with suicidal ideation and withdrawal from substance use.

  • Psychiatric intensive-care unit

This is when the patient is in imminent danger of harm to self or others. Their needs are higher and the nursing care is of a higher degree. Two nurses assigned for every patient. 

Who is it for: Patients who are in danger of self-harm or are so violent they need to be contained.

  • Long-stay ward or long admission

Here, the patient is admitted for rehabilitative work. This includes treating patients with therapy to help them recover from their mental illness and restore their ability to function in the community.

Who is it for: Patients with addiction or, chronic and enduring mental illnesses.

Before the deinstitutionalization movement of the late 1960s, patients could be committed to living in an asylum/institution for the rest of their lives. Following the movement, this is no longer an option. Now there is an attempt to integrate patients back into society and community care (such as assisted living and half-way homes).

  • Respite

A short stay of about a week to ten days to get away from immediatestress such as the loss of a job, a change in the family situation or even after a stressful project.

Who is it for: Patients who are dealing with stress or have just gone through a high-stress situation.

In some hospitals, psychiatric facilities may be divided by age group. For example, a children's psychiatry ward may have patients below the age of 18 whereas a geriatric ward may have patients above 65. This is so that everyone can receive care according to their specific needs.

When do patients require admission?

In the following instances (a non-exhaustive list)

  • When there is a risk of bodily harm to self or others

  • When their condition is acute but they refuse treatment

  • When a patient needs to be observed for a clearer diagnosis

  • When the patient is prescribed complex medication which requires time for their symptoms to stabilize

  • Lack of adequate social support in the community to support recovery (for eg, a student who is living away from home and does not have a social support system, who is in need of a structured environment for the period of their recovery)

  • Drug detoxification

  • When there is a physical and mental illness that needs to be treated holistically

Even if a patient fits any of the above criteria, a mental health professional must be consulted before considering in-patient admission.

What do I do if someone I know is refusing admission?

The law has a provision for someone who is refusing admission. Supported admissions are beneficial to people who have a high need for care that can be provided by mental health professionals, and that their caregivers can’t provide; and who don’t have an understanding of the extent of the issue due to the nature of their illness.  For example persons with schizophrenia may not be aware that they are in need of treatment due to psychotic episodes.

In these circumstances, at the request of a nominated representative or (where there is no nominated representative) the closest family member, a mental health establishment can accept a person as a  patient even when they are refusing admission. Two psychiatrists are required to assess and agree to the need for admission against the will of the person. Treatment though is always given with the consent of the patient except in cases of emergency or when the patient lacks the capacity to give such consent (in which case, the nominated representative or nearest of kin can give consent on behalf of the patient for treatment).

The Act grants more power to the person who is getting admitted to the psychiatric hospital and aims to create a rights-based language that will lead to fewer instances of injustice when it comes to admission to a hospital. To access detailed rules of admission, treatment and discharge at a psychiatric hospital, read Chapter XII (section 85 to section 99) of the Act.

Written with inputs from Dr Divya Nallur and Dr Sandip Deshpande