The Psych Ward: What is a Psychiatric Hospital Really Like?

What is a psych ward?

In the United States, a psychiatric ward, psychiatric unit, or behavioral health unit is a place where people go to get help for severe mental health issues. It is in a hospital setting and provides a safe environment with 24-hour monitoring by trained staff.

Having a serious mental health issue on its own does not automatically mean you need to be in a psychiatric facility. But you may consider seeking admission if you think that you are likely to cause harm to yourself or because your mental health has affected your judgment to the point where you are putting others at risk. Specific mental health issues that may warrant inpatient psychiatric treatment if they are severe enough include:

• Depression
• Anxiety
• Bipolar disorder
• Schizophrenia
• Eating disorders

Of course, the prospect of being admitted to a psychiatric unit can be a frightening one. Psych wards are often portrayed in a negative light and there can still be a great deal of stigma associated with seeking inpatient mental health care. However, while everyone’s experiences are different, by learning about what inpatient psychiatric care in the U.S. is really like, you can better decide if it’s right for you or a loved one.

How long is a psych ward/psychiatric hospital stay?

Over the years, the average length of stay for inpatient mental health care has been getting shorter. In 2018, the average stay for adults in the U.S. lasted between five and seven days. Long-term hospital admissions that lasted weeks used to be routine decades ago but are now rare.

Obtaining inpatient psychiatric treatment

While some psychiatric hospitals allow people to seek admission directly, most people in need of inpatient psychiatric care go to a hospital emergency room first.

In the emergency department, you or your loved one will undergo a comprehensive evaluation that often involves an interview, lab work, and a physical. Using this information, a team of mental health providers will determine the best level of care for your needs.

Many facilities use the Level of Care Utilization System (LOCUS) to guide their assessment and determine the right level of care. The highest level of care they can assign to someone is involuntary inpatient, followed by voluntary inpatient.

Involuntary psychiatric care

If someone is at grave risk of harming themselves or someone else, then it may be necessary to admit them against their will. State laws differ, but qualified professionals usually make this determination, rather than family members. However, family members can be an important source of information.

[Read: How to Help Someone with Mental Illness Accept Treatment]

Voluntary inpatient psychiatric admission

The emergency medical team will refer you for voluntary psychiatric inpatient care if you are at risk for harm but are willing to get help. During voluntary admission to a psychiatric unit, you usually retain the right to leave, but this depends on what state, province, or country you are in.

Other levels of care

After meeting with you, the emergency mental health team might decide that an outpatient level of care might be best for you. If so, they will give you some options and make a referral.

Preparing for admission to a psychiatric ward

If the emergency mental health team refers you to inpatient psychiatric treatment, they will arrange to get you to the unit. If it is in the same building, they will walk you there. If it is somewhere else, they will arrange transportation.

What to bring with you

Most of the time, you cannot go home between the emergency department and the psychiatric hospital, so arriving at the emergency department prepared for your inpatient stay is best. Here are some items to consider bringing with you.

Clothes. Many units will let you bring your clothes, but some will not. If you do bring clothes, bring about three days’ worth, and avoid the following items because they can pose a safety hazard, and the hospital might not let you keep them:

• Drawstrings
• Belts
• Shoelaces
• Scarves

Medication. This also varies between hospitals. You should at least have a current medication list with the names and dosages of the medications you take.

If you bring items you cannot have on the unit, consider having a plan to get them picked up and brought home. Hospitals may be able to lock up your belongings and return them to you when you leave, but they do not always have that ability. Items that you might want to call ahead to find out about include:

• Electronics (tablets, computers, cell phones).
• Personal grooming supplies (makeup, lotion, shampoo).
• Medical equipment (CPAP, walker).

What not to bring with you

Items that you can easily use to harm yourself or others are unlikely to be allowed into a psychiatric unit, as are items that are counter-therapeutic. Prohibited items usually include:

• Razors, knives
• Glass bottles
• Metal objects
• Drugs or paraphernalia
• Plastic bags

The admission procedure

Once you arrive at the unit, there is usually an admission process. This process might include the following steps:

Paperwork

There will be several forms to sign and complete upon admission. These may include:

• Treatment consent.
• HIPAA privacy policy.
• Patient bill of rights.
• List of people who are allowed to know about your presence in the unit.
• List of people from whom you are willing to accept phone calls.

If you have a psychiatric advance directive, this is when to let the staff know. A psychiatric advance directive is a legal document you would have filled out beforehand that communicates your treatment preferences. You can also name a healthcare proxy.

Safety search

A staff member will look through your belongings for objects that could be used to cause harm to yourself or other people, such as strings, sharp or heavy objects, and drugs or medications. Some units allow you to keep your cell phone; some do not. Anything not allowed on the unit will usually be locked somewhere and returned to you at discharge.

The safety search will usually involve a search of your body. In some hospitals, this will involve disrobing. This process is performed in a private area away from other patients.

Admission interview

Clinical staff will sit down with you and ask about what brought you to the hospital, your health history, the medications you take, and your alcohol and substance use. The interview can take from 30 minutes to over an hour, depending on the complexity of your medical history.

A day-in-the-life of a psychiatric hospital

You may find that the inside of a psychiatric ward bears little resemblance to how movies often portray it. Most programs more closely resemble a conference or an indoor camp with added medical treatment.

The other patients’ mental illnesses are unlikely to be obvious. While other patients may share some of the challenges they are experiencing with others, their reason for being there is rarely known to anyone but the treatment team and themselves.

Medication administration

Most hospitals do not allow medications to stay with patients. Medications are usually administered in a designated area, or privately by a nurse.

Meeting with your treatment team

You will usually meet with a psychiatric team leader once a day. Other staff members, such as a nurse or social worker, may also attend the meeting or meet with you separately.

They will ask you about how your treatment is progressing, and make any needed adjustments. Patients have a right to opt out of this meeting, but it is advisable to attend because this is when decisions about your treatment are made.

Skills and education groups

Many inpatient settings hold therapy groups. These groups teach skills that can be immediately applied, such as cognitive reframing or setting boundaries with others.

A common misconception is that inpatient groups involve sharing personal problems with others. This is usually not true in inpatient settings.

Free time and recreational therapy

Units may vary widely around how much free time they schedule. Some only schedule an hour at the beginning and end of the day, while others may schedule larger chunks of time. Some units offer more structured recreation activities instead of free time, such as recreational therapy groups that teach you how to wind down in healthy ways.

Art supplies, board games, books, and puzzles are often available to patients in inpatient units. Many units have a television available, although there may be rules about what type of programming is allowed and when the television can be turned on.

Meals

Hospitals usually serve meals individually to each patient. Most states have infection control rules that prevent a family-style or buffet-style serving method. How this looks varies, but most hospitals will offer you a choice between a few options. They will also accommodate most special diets, such as vegetarian or vegan, and any diet ordered for medical reasons, such as no sodium or low FODMAP.

In some hospitals, patients may be able to go to the hospital cafeteria accompanied by staff.

Visitors

It is common for there to be restrictions on the number of visitors who can come to see you at one time. These restrictions are usually for security, since hospitals must maintain a safe environment to protect patients from hurting themselves or others.

There are usually specific visiting hours. Depending on the level of security at your hospital and your own personal circumstances, staff may supervise visits to prevent any possibility of your visitor giving you prohibited items.

Laundry

Patients almost always have access to laundry facilities in units where they can wear their own clothes. If it is a large unit, you may have to schedule a time to do your laundry. The facility will usually provide laundry soap, but it would be good to check ahead of time as they might make you pay for it.

Showers

You can expect to be able to shower privately from other patients, but depending on your level of precautions, staff may need to check on you or be present to maintain your safety.

Showers are usually located in a locked area and tend to be available only during scheduled free time.

Staff checks

Staff will check on you frequently throughout the day and night as part of the strategy for maintaining your safety. If you are at extremely high risk of harm, you may be assigned a staff member who will remain close by and always have eyes on you.

Seclusion and restraint

Most people who are admitted to a psychiatric unit do not experience seclusion or restraint. In 2023, for every 1000 hours of patient care delivered in the U.S., less than 1 hour was spent administering seclusion or restraint.

If it were to happen to you, it would be because you were in the act of trying to harm yourself or someone else, and other means of de-escalating the situation did not work. Situations where a restraint might be needed could be during a hallucination, a suicide or self-harm attempt, or when someone cannot control their anger and lashes out violently.

A restraint can take the form of a quick manual hold or, if a longer duration is needed, you may be placed in a specialized bed. Alternatively, some facilities may choose to keep you safe by separating you from other patients and placing you in a locked room where there is nothing available to use for self-harm. This practice is known as seclusion.

Staff watches you constantly while in seclusion, either by sitting near you, watching through a window, or via video. Both seclusion and restraint are used as a last resort and for the minimum possible time.

Advantages of inpatient treatment

The inpatient unit is a safe environment. It is harder to harm yourself in an inpatient psychiatric unit. Many units are constructed in a way that makes it difficult to tie a string to anything. Objects that have the potential to be harmful are restricted from entering the unit, and there is 24-hour staff monitoring.

Social support. Loneliness and social disconnectedness are often a significant contributor to poor mental health. Even for people who are not lonely, they may benefit from being around others in similar situations. It helps you know that you’re not the only person experiencing these issues. Seeing people around you start to feel better can also give you a sense of hope.

Stability and routine. The stability and routine you encounter in a psychiatric ward may be directly helpful to recovery. Therapies that incorporate daily behavior habits, such as interpersonal social rhythm therapy, show a positive effect on illnesses such as bipolar disorder. While most units are not yet formally incorporating social rhythm therapies, adhering to a daily routine where light exposure, eating, and social activities happen consistently, can help you establish stability and routine.

In-the-moment coaching. Having someone nearby to coach you in applying your newly learned skills when you need to use them can be helpful. In an inpatient facility, staff are present around the clock and can coach you when a crisis happens. In a hospital, you can get real-time coaching in situations such as dealing with cravings, having a bad phone call, and setting boundaries.

Disadvantages of inpatient treatment

Being limited from seeing family and friends. Many units limit the number of guests you can have and when they can visit. If your family and friends are supportive, you may find it harder to get support from them while you are an inpatient. This is especially true if the hospital is located far away from your network of friends and family.

Limited access to coping skills. Because inpatient units are such heavily controlled environments, it can be difficult to access the usual coping skills that you might use. For example, listening to music on a unit that limits electronics access may be difficult. If you are used to running to let off steam, it’s unlikely you’ll be able to leave the unit to do that.

Some people have reported feeling worse. Some people have reported that measures taken to ensure safety in the psychiatric unit aggravated their trauma and led to increased anxiety. Being restrained by staff, witnessing other patients being restrained, or seeing others cause themselves harm, argue, or fight can all have a negative impact.

Leaving

The goal of inpatient treatment is to get you or your loved one to a place where you can manage without 24-hour nursing supervision in a safe environment.

Once the acute phase of the crisis has passed, the treatment team may start to consider discharging you. This does not mean that treatment is complete. Most people need to continue their treatment once they leave. You may continue in a residential substance use treatment facility, attend an intensive outpatient program while living at home, or continue with counseling and medication management appointments.

Who decides when it is time to leave the hospital?

The treatment team leader—usually a psychiatrist, a psychiatric nurse practitioner, or a physician’s assistant—will write the order to discharge you. However, other team members such as your primary nurse and social worker will also have to sign off on it.

Ideally, your discharge date will not be a surprise. Every day you meet with your treatment team, you should talk about where you are with your goals and what needs to happen before you can be discharged. Your input on this topic can be crucial in deciding the right time to leave.

What if I want to leave before my team is ready to discharge me?

If you are a voluntary patient, what happens in this situation differs from state to state. In some states, you can be prevented from leaving while your treatment team decides if you can be discharged against medical advice. This can take a couple of days, and you may have to put your request in writing.

In other states, a hospital cannot prevent you from leaving at any time, day or night, unless they determine that you are likely at risk of harming yourself or someone else upon discharge. In this situation, they would have to convert your status to involuntary if you meet the criteria.

Finding the right place to get inpatient care

Researching ahead of time may help you decide on the right inpatient unit for you or your loved one. Here are some ways you can evaluate a potential facility.

Check for adequate staffing

Due to how hospitals are reimbursed, there can be pressure to cut nursing services to save costs. When staffing is cut too aggressively, there may be insufficient staff to prevent events that lead to seclusion and restraint.

While there is no universal standard for staffing psychiatric inpatient units, the law in California provides a good reference point. In California, psychiatric units must have a minimum nurse-to-patient ratio of one to six. Some states collect and publish information about hospital staffing ratios. You can also find out how a unit is staffed by calling the unit and asking.

Check the rates of seclusion and restraint

Restraint and seclusion can happen in psychiatric settings when a patient is attempting to harm themselves or someone else. When this occurs, it can often be traumatizing to the person involved as well as those who witness it. For this reason, an environment where there is less of this practice is usually more therapeutic. Depending on where you live, you may be able to look up the rates of restraint and seclusion in your local hospital. Lower than average is better.

In the U.S., the Centers for Medicare and Medicaid (CMS) collects data on seclusion and restraint in hospitals and makes it available to the public.

Evaluate how you are treated when you call

The culture of a unit can be difficult to judge from statistics and printed material, so another thing you can try is to call the unit directly and ask questions about what you can expect.

• How are you treated when you speak with someone on the unit?
• Were you treated with respect?

How staff treat you when you call can give clues about how you or your loved one would be treated as a patient. You can also look for reviews about a facility from former patients, as well as the admitting hospital emergency department.

Last updated or reviewed on August 21, 2024