What it's like to get inpatient treatment for depression
Sen. John Fetterman made headlines in mid-February, after his spokesperson announced that the Pennsylvania Democrat was receiving inpatient treatment for depression.
Adam Jentleson said in a statement on Twitter that Fetterman checked himself into Walter Reed National Military Medical Center in Bethesda, Md., to receive treatment for clinical depression. "While John has experienced depression off and on throughout his life, it only became severe in recent weeks," the statement read. "After examining John, the doctors at Walter Reed told us that John is getting the care he needs, and will soon be back to himself."
The senator's wife, Gisele Fetterman, also tweeted about her husband's inpatient treatment, writing, “After what he’s been through in the past year, there’s probably no one who wanted to talk about his own health less than John. I’m so proud of him for asking for help and getting the care he needs."
Fetterman suffered a stroke last May and was elected in November. He went to the George Washington University hospital in early February after feeling lightheaded, his office said in early February. He was discharged two days later.
But the news of his treatment has raised a lot of questions — and confusion — about what it means to receive inpatient therapy for depression. Patients who have been through it, as well as doctors, explain.
What is inpatient treatment for depression?
Mental health therapy is generally divided into two broad camps: outpatient, when you see a therapist in their office, and inpatient, where you stay at a facility to receive care, Dr. Thea Gallagher, a clinical assistant professor at NYU Langone Health and co-host of the Mind in View podcast, tells Yahoo Life. "Inpatient treatment means you need a higher level of care than what you would receive outpatient, which is probably once a week, or even less than that."
People who enter inpatient care generally do so because they feel they are in a state of crisis, not as stable as they feel they should be, are a danger to themselves or others, or aren't able to go about their daily functions, Gallagher explains.
"In an inpatient setting, the care setting is much more intensive than outpatient treatment," Dr. Erick Cheung, the interim chief medical officer of the Stewart and Lynda Resnick Neuropsychiatric Hospital at UCLA, tells Yahoo Life.
On a basic level, "inpatient treatment typically means staying overnight in a psychiatric hospital for more intensive treatment — evaluation and testing, psychotherapy, medication management, providing a safe environment during a time of mental health crisis and a team to help coordinate planning and care for outside of the hospital," Elizabeth Shultz, assistant professor of clinical psychiatry at Vanderbilt University Medical Center, tells Yahoo Life.
A person can voluntarily go into inpatient care, which is when they decide to admit themselves, or they may be involuntarily admitted, which "is often decided by a medical professional" if it's "deemed you are a risk to yourself or others," Hillary Ammon, a clinical psychologist at the Center for Anxiety and Women's Emotional Wellness, tells Yahoo Life.
What is inpatient treatment like?
It's largely tailored to the needs of the patient, Cheung says. Because of this, everyone's experience — and every treatment center — is slightly different.
But in general, "there is a combination and array of group therapies that occur," he says. "Patients typically meet in small groups to do different types of activities and rehabilitation, and then have one-on-one meetings with doctors, therapists and nurses."
Patients are assigned to a treatment team including a psychiatrist or psychiatric nurse practitioner, social worker, nursing staff and other mental health specialists, Shultz says. In addition to individual and group therapy, "there may also be times for educational sessions — on medications, nutrition or physical activity," she says. "Often there are set visitation times and other opportunities for extra rest, reflection or relaxation throughout the day."
Shultz says that a treatment team will meet with a patient to talk about ongoing assessments, symptoms, treatment recommendations, readiness for discharge and next steps after hospitalization. "While medication is often prescribed or discussed, being admitted to the psychiatric hospital does not automatically mean that you have to take medication," she says. "For many people, because of the severity or cause of the symptoms that led to being hospitalized, medication can be beneficial. However, there are certainly people for whom medication is not part of their treatment plan."
The length of stay may vary based on a patient's needs, but Ammon says it usually ranges from two to 14 days.
'Everything just started crashing around me'
Allison Krawiec-Thayer tells Yahoo Life that she spent six days in inpatient treatment in 2018, after developing depression when she and her spouse moved to a new city. "One day, after my anxiety and depression had been growing steadily for weeks, everything just started crashing around me," she says. "My thoughts shifted to a darker place than they ever had before, and the hopelessness was profound. Even though I didn't have a plan and hadn't tried anything, I knew that it was time to go inpatient."
Krawiec-Thayer says she was "definitely sad" the first few days of her treatment. "I remember crying into my spouse's chest in the Lyft on the way to the ER," she says. "I called home every day and reminded myself that I was moving in the right direction."
Her treatment was rooted in dialectical behavior therapy, a form of therapy designed for people who experience intense emotions. "We had group sessions that ranged from talk therapy to making music together," she says. "There was free time outdoors at the rec court on the roof of the building. I spent time with fellow patients playing cards and watching movies."
Krawiec-Thayer says she received a visit from a therapy dog, there was a tai chi group in the mornings and she was able to meet and pray with a chaplain. "I also met daily with members of my medical team to discuss medication and how I was feeling," she says. "The beauty of being inpatient is that I truly had nothing else to worry about and could focus solely on my healing. I circled the food I wanted on a menu and it appeared. I didn't have to do my laundry or clean. If I felt a panic attack coming on, I could ask a nurse to sit with me. My cellphone wasn't there as a constant distraction and outside pull. I had space to move through what I needed to, so I could come out of the hospital renewed."
Ultimately, Krawiec-Thayer says, "I knew that this was the right choice for me."
What are the signs someone might need inpatient treatment?
The severity of a person's symptoms matters, including how much it's impacting their functioning, Gallagher says. "If people are actively, severely suicidal or their functioning is impacted — they're not going to work or school — one hour a week of therapy will not have the same effect as inpatient treatment," she says. "You need a higher dose of care."
Inpatient care may also be recommended "when there is a need for more rapid diagnosis, treatment or coordination of services due to the severity of symptoms," Shultz says.
Doctors stress that inpatient treatment should be normalized
There is a lot of stigma surrounding inpatient treatment for depression, and Fetterman's recent decision demonstrated that it persists, despite gains in the way Americans broadly view mental health. On Twitter, people have labeled him "mentally unstable" and as a "mentally and physically disabled" patient, among other things.
People who seek inpatient care are often aware of this stigma. The novelist Wednesday Lee Friday tells Yahoo Life that she felt a "vague sense of shame, a feeling like I should have been able to deal with all of this without hospitalization," when she sought inpatient therapy 26 years ago after a suicide attempt. "I eventually realized that was like telling a diabetic to control their blood sugar by thinking it through," she says. "Illnesses need treatment — full stop."
Doctors say that it's important to normalize all treatments for depression, whether inpatient or outpatient. "Depression is a very common illness and diagnosis," Cheung says. "It's part of the human body. If you had a pneumonia and you needed help with breathing, you would go to the hospital. If you had a heart attack, you would go to the hospital. It's the same with depression. If you had a severe form of depression and needed assistance, you should seek treatment."
Ammon agrees. "Inpatient care is necessary for some, whether it’s short-term care for stabilization or long-term treatment," she says. "This higher level of care can save lives."
Krawiec-Thayer says she has "grown and transformed" since her inpatient treatment. "It's also a much more nurturing experience than I expected," she says. "The media makes it out to be pretty intense sometimes, but, honestly, my experience was super peaceful and healing."
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