If i check myself into a mental hospital can i check myself out

All Illustrations by Esther Sarto for BRIGHT Magazine.

On the way home, my heart raced. I kept driving, desperate to make it home, but I could barely feel my body. My legs had gone numb. I knew I was in the throes of a full-blown panic attack. I tried hard to focus on breathing, but it didn’t relent. When we got home, my kids turned on a movie. I went into my room and closed the door. All I could do was get in bed and pull the covers up over me. I lay there sobbing and shaking.

It was a holiday weekend and I wasn’t sure if I’d be able to reach a doctor, but I started making calls. I tried to get in touch with my psychiatrist, and when I didn’t hear back, any psychiatrist. The only person who called back was my therapist, who said, “If you get desperate, you know you can always go to the hospital.”

I was desperate. I had never had a mental health issue like this before, save for a few bouts of anxiety that mostly affected me at night. I had no idea what checking myself into the hospital for a psychiatric issue would look like, but I was certain nothing could be worse than what I was experiencing. I told the kids I was getting a migraine (I had had one the previous month, so this was something familiar and believable) and drove them to my mother’s house.

I arrived at a well-known public hospital in Baltimore and sat in the waiting room, sobbing and hyperventilating. I didn’t care that people were staring at me. For hours, I waited in a hallway bed and the emergency room doctor gave me a pill for anxiety. Finally, all of my belongings were sealed in a plastic bag and I was sent upstairs to the psychiatric overflow area, where I was hopeful I’d soon see the on-call psychiatrist. I lay on a tiny bed without a pillow, staring at the ceiling. I sobbed and slept, and when the drug wore off, I started to panic again. I cried without restraint and I heard whispers from the nurses’ station. But no one came to me.

Finally, I asked for help. It was nearing midnight and I’d been in the hospital since 4:30 p.m., and I still hadn’t seen a psychiatrist. I asked the nurse when the doctor would be coming. She shrugged her shoulders. I explained that I was really struggling and that my anxiety was out of control. She stared at me, straight-faced, and asked if I came looking for drugs. “I came for help,” I told her through my sobs. Defeated, I went back to my room. Around 3 a.m., a psychiatrist came in. Finally, someone wanted to hear what was going on and why I was there. We talked for five minutes, not nearly long enough to delve into the range of emotions swirling through me. But I felt some minor relief that at least there was a plan. A few minutes later, I was given a pill (I don’t know what it was, and there was no record of it when I later asked) and I quickly fell asleep.

At 5 a.m., I was told the psychiatric unit still didn’t have a bed, so I was being transferred to another hospital. I didn’t recognize the name. I didn’t know how far away it was or how I was getting there. Around midday, the transport team finally arrived. At check-in, I was asked no questions about my mental state. I signed a 72-hour hold, so I knew I would be staying for at least three days. Aside from that, I was given no instructions, schedule, or information about what to expect. I roamed the hallway for hours, lay in bed, and waited — for what, I wasn’t sure. It was my second night in a hospital and I still didn’t have a treatment plan. By evening, I was getting hysterical again. I expressed concern that I hadn’t yet been seen or talked to by any professional and I was quickly put in my place. “No one’s coming to see you tonight!” a nurse barked at me.

The following day around noon, a psychiatrist finally stopped by my room. We talked for just a few minutes. I found her cold and uncaring, but I felt comforted anyway that someone with a prescription pad was speaking to me. It was the third day and with the knowledge that treatment was on its way, I could breathe a little easier. But that evening, I hadn’t yet received medication, and I started to panic all over again. I sobbed outside of the glassed-in nurse’s station, while the on-duty techs and nurses ignored me as best they could. Finally, I got one nurse to check the computer and she realized the psychiatrist had never put in the order for my medication. It would be hours more before it went through, before I could finally get some rest.

I’d like to call it all a fluke, but I soon realized that I was being treated on par with just about everyone else, even those in more urgent need. There was a 25-year-old man who’d taken a bottle of pills the night before he entered the hospital, but now that he was here, he wasn’t getting his regular medication for several days after his arrival. Another man, who’d been there longer than I had, told me the psychiatrist had failed to put his medication in, too. As I lazed around for days, there was no therapy, activities, or anything that would promote wellness. I spent most of my time pacing or coloring in flowers in a coloring book. Once, I played cards with another patient. The unit seemed like little more than a holding area, one that bred isolation rather than wellness. I couldn’t help but think that it could drive the “sanest” person to a mental breakdown.

In public hospitals, like the one where I stayed, in-patient care is costly. “Despite the parity law from 2008 (mandating equal insurance coverage for mental health issues), oversight and enforcement are lacking and many loopholes remain,” he says, which means there can be limits on things like length of stay, and what treatments may be covered. “Low reimbursement rates help drive qualified professionals away from this work, which end up hurting quality of care.” Essentially, that means insurance companies, more than providers, control patient care. “Patients end up receiving only custodial care, rather than therapeutic, optimal care,” Shpancer says.

Even though I was in a psychiatric unit, physical problems seemed to take priority. That became clear to me on the last night of my stay. I fainted while walking down the hall around midnight, a result of low blood pressure from the new medication in my system. A moment later, I woke on the floor, drenched in sweat and surrounded by every nurse in the unit. I was offered ginger ale and helped back to bed. It was just about the only time I was attended to without seeking help myself.

I couldn’t escape the feeling that, while there might be plenty of other systematic issues at play, some of the poor care came from a lack of understanding — and thus, little compassion. People living with mental health conditions commonly report feelings of poor treatment, even feeling dehumanized, by the same professionals who are trained to understand those very conditions. Shpancer says it’s because stigmas about mental health are still relatively widespread, even among professionals. “Depression is no more your fault than cancer. You have less personal control over developing schizophrenia than over heart disease.”

Tricia Kostin, the clinical director at an outpatient center in Florham Park, New Jersey, says that the rise in suicide over the years has, perhaps ironically, helped destigmatize and improve treatment for some mental health issues, like depression and anxiety. “However, stigmas surrounding severe mental health issues, like bipolar disorder or schizophrenia, still run rampant,” she says. “Society is more open to helping someone that can be ‘easily fixed’ with talk therapy and medication, as opposed to those that require more intensive services and length[ier] therapy stays.” That might mean patients that are most difficult to treat will have the most hurdles in terms of how they are treated.

My own treatment didn’t improve over the remainder of my stay. On the plus side, over time I learned the best way to get care: I just needed to act like the perfect patient.

I had to act more pulled together than ever just to be treated like a human being with real needs, even in the direst time of my life. I had to play the game — pretend I was fine so that I wasn’t viewed as a problem, ignored, or forced to lengthen my stay. I had come to the hospital willing (desperate, actually) to receive help, which I assumed meant being honest about what I was feeling. But over time, my mindset shifted, first to understanding that the help was very limited, and next to playing the game of looking like I was better so that I could simply go home.

As I looked around, I felt privileged to understand this dynamic. I could easily pick out the patients who understood it, too, and the ones who had yet to learn it (or didn’t have the mental capacity to). It was hard to ignore that the ones who were the least well were the most ignored.

During the last couple of days, I mostly kept to myself. I was still struggling emotionally but if I needed to cry, I didn’t let anyone see. I closed my door and cried quietly. When the psychiatrist came to chat, I talked slowly and calmly so she wouldn’t think I was still panicking. I smiled and told her I was feeling fine and looking forward to getting back to my life. That wasn’t true; I was utterly terrified of it.

Still, I was grateful to get out of my environment for a few days and equally relieved to start a medication that would help me feel more capable at an immensely difficult point in my life. Aside from that, the health care in the mental health unit was deeply lacking.

If I had to do it over again, it’s hard to say what choice I would make. What better options are there for emergency mental health care? Private mental health hospitals would likely be more patient-centered, but they often have waiting lists with specific criteria, unless there’s an immediate suicide risk. After I returned home, I called a well-known mental health hospital close to home and asked some questions about intake. Turns out they don’t take my insurance, but I wouldn’t have been accepted anyway based on my condition. And private hospitals can have their own set of problems, like profit-driven clinical care. As an example, in 2017, Universal Healthcare Services, the largest chain of psychiatric facilities in the country, was investigated for keeping patients longer than necessary in multiple hospitals.

I asked a friend who works in the mental health field what she would tell someone in my situation to do. She told me about a 24/7 nonprofit crisis center in my city. It’s the only comprehensive crisis service anywhere close to where I live. Most major cities have something similar — nonprofits that offer low-cost (or even no-cost) care for psychiatric patients or drug-addicted individuals in need of emergency treatment. Of course, they aren’t as easy to come by as public hospitals, especially in rural areas, and the quality of care will depend in part on how much funding the area has to treat patients. But it seems like a quality option for those lucky enough to live near one.

Crisis hotlines can also help tide people over until they can meet with a psychiatrist, find in-patient treatment, or be matched with other appropriate options.

As it stands, hospitals psychiatric units are still the place where those who most need treatment are going to end up, but the treatment rarely offers what psychiatric patients need — attentive, compassionate care. For the most at-risk, the quality of care may end up being yet another thing from which to recover.

I think often about the end of my first meeting with the psychiatrist. “Do you feel better now after getting it all out?” she asked while getting ready to leave the room. We had been together for just a few minutes. I nearly laughed out loud. I hadn’t begun to scratch the surface of what I was going through, and it felt utterly demeaning to suggest I felt better. I felt like protesting, but instead, I played the good patient. I thanked her and she left. Overall during the four days I spent in the hospital, I had spent about 20 minutes with a professional.

In the end, I healed, for the most part, on my own. I hadn’t been given any practical advice when I checked out of the hospital, other than to take my antidepressant, which of course I did. But I also self-prescribed my own care items that I imagined would help me to keep moving in a positive direction every day. I exercised, went to bed early, focused on work and my kids, and overall, got back to my routine. I pursued my own therapy and paid out-of-pocket when the in-network therapist the hospital set me up with stared at me blankly for an hour in lieu of asking any questions or giving me signs that she was committed to my treatment. And when I felt ready and grounded, I got back to seeing my friends.

For me, the hospital psychiatric ward would be a memory, one that in all likelihood I’ll never have to repeat. For others, it would be, and already is, part of a vicious cycle that will require a much higher standard of care, compassion, and competency to truly break.

Editor’s Note: If you’re having suicidal thoughts, please send an email to The Samaritans. They are trained volunteers that provide a free service 24 hours a day. Their website is available in 15 languages.

If you’re in the United States, you may also call the National Suicide Prevention Lifeline on 1–800–273–8255. If you’re in Kenya, send an SMS to 22214.

If you or someone you know is struggling with suicidal ideation, practical advice is available at Reporting on Suicide and The Lifeline Canada Foundation.

Recovery is possible. Most people who think about suicide do recover. Timely treatment and intervention work.