When is Psychiatric Hospitalization Necessary?

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When is Psychiatric Hospitalization Necessary?

April 12, 2016
Hospitalization

Bleeding. Broken bones. Chest pain. Shortness of breath. It’s pretty easy to know when it’s time to take your child to the hospital over a physical concern. When it comes to mental, behavioral or emotional issues, the issue of hospitalization may not be so simple or clear cut. We may think our child is throwing a tantrum, acting out or in need of a good night’s sleep. However, Psychiatrist and Senior Medical Director of Clarity Child Guidance Center, Dr. Soad Michelsen, cautions parents to pay attention to one critical factor when debating hospitalization for your child. “The big word is safety. That’s the bottom line for inpatient care. If your child is in danger of harming themselves or someone else, it’s time to take them in.”

Is your child’s safety at risk?

Dr. Michelsen clarifies that there is a difference between suicidal or homicidal thoughts and intent. “There are three parts, the thought; the intent; and the plan. If your child has at least one of the three, then your child should be assessed to determine if he or she needs inpatient care.”  Dr. Michelsen also points out that it is important to take the child’s age into account when determining intent. As an example, “A teenager may be cutting themselves, but it might not be a suicide attempt.” Instead it may be an inappropriate response to stress, depression or anxiety. While the child would still need to be seen for therapy and treatment, that situation may not require inpatient hospitalization. Conversely, “If a 5-year old bangs his head on the wall and says ‘I don’t want to be alive,’ or ‘I want to go to God,’ that is a suicidal attempt because it is an age appropriate attempt.” To clarify, a 5-year old child may think that banging his head on the wall could actually kill him. While that might not be alarming to a parent in regard to the child’s physical health, it is alarming in terms of his/her mental health and should be treated as an intention to end his/her life.

Additional reasons for Immediate Assessment

In addition to the safety concerns that Dr. Michelsen addresses, Depression and Bipolar Support Alliance offers up the checklist below to determine whether or not your child should be assessed at a psychiatric hospital. Your child may need to be seen immediately if they,

  • Threaten or try to take their lives or hurt themselves or others.
  • See or hear things (hallucinations).
  • Believe things that aren't true (delusions).
  • Have problems with alcohol or substances.
  • Have not eaten or slept for several days.
  • Are unable to care for themselves, e.g., getting out of bed, bathing, or dressing.
  • Have tried treatment with therapy, medication, and support, and still have a lot of trouble with symptoms.
  • Need to make a significant switch in treatment or medication under the close supervision of their doctor.
  • Have any symptom of mania or depression that significantly interferes with life.


It’s hard for parents, too.

In addition to checking the symptoms for hospitalization, parents may also waver on the decision due to the physical separation from the child. If the inpatient hospitalization is with Clarity Child Guidance Center, some of that separation is eased with family therapy. Dr. Michelsen explains, “It’s never easy to admit a child to a psychiatric hospital. For one reason, you cannot sleep over. They won’t set a bed up right next your child. So there’s a lot of trust involved.” Understandably, this can be a hurdle for some parents. When a child is in a traditional hospital, you’re able to see most moments of your child’s care. You’re able to ask questions as procedures are happening. Since that isn’t the case with psychiatric inpatient care, parents must establish some level of rapport. Parents must break through the fear of, ‘Am I doing something wrong by asking too many questions or being too involved?’” Dr. Michelsen reiterates, saying, “Parents should get to know who is working with their child, both the nursing staff and the therapist. They should also expect to receive family therapy as part of the treatment.”

What Happens after Hospitalization?

If hospitalization turns out to be appropriate for your child, it’s important to manage your expectations of the experience. In our society, we’re used to quick fixes. If our child has appendicitis, we take them to the hospital, our child gets surgery, our child is released, and then it’s done. Problem solved. Unlike that kind of medical emergency, a child that’s admitted for mental, behavioral or emotional issues, isn’t “all better” when they leave an inpatient stay. Dr. Michelsen points out that, “When a child comes in for the first time, there is a safety concern, so the improvements parents can expect see are in terms of safety. In other words, the child doesn’t come in with a problem and leave without problems. But the child and parents come out with a better understanding and education of what to do with reoccurring symptoms.”

If your child is experiencing extreme distress and you’re not sure whether or not it merits hospitalization, it’s important to err of the side of caution. With Clarity CGC’s Crisis Assessment Center a child who is experiencing a mental health crisis has a place that they can go to and be assessed right away. The child will be evaluated by a therapist, a nurse and a psychiatrist to determine what level of care and treatment he or she needs. If its determined that the child or adolescent requires acute, 24/7, inpatient care, there is a seamless transition to an available hospital bed.  

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