Hospital admissions for mental illness

Just as people may require admission to hospital for assessment and treatment of their physical health problems, some people may require admission to a mental health (psychiatric) inpatient unit for the assessment and treatment of their mental health problems.

Depending on a person's needs, the severity of symptoms, their level of distress and risk of harm to either themselves or others, treatment may be provided in their own environment in the community, or in hospital within a specialist mental health inpatient unit.

For the majority of people an admission to a mental health unit is planned between themselves and their doctor or mental health care specialist. For others it is the result of a person being in a mental health crisis requiring immediate treatment to assess and manage risk and alleviate distress.

This may be the person’s first experience of mental illness, a repeat episode or the worsening of symptoms of an often continuing mental illness. Admission under these circumstances may be voluntary or involuntary.

Initial assessment

A thorough assessment of your needs will be undertaken by a team of mental health specialists which include medical experts and allied health professionals. The assessment involves gathering information from you, and where appropriate, your family, carers, and any health care providers about your:

• current mental state
• risk of harm to yourself or others
• past mental health history
• physical health
• alcohol and drug use
• personal and social history
• social situation.
• strengths and goals.

Treatment plan

Your assessment will help you and the mental health team develop your treatment, care planning and recovery which may include ways in which to:

• manage and improve your mental health
• identify early warning signs and develop strategies to prevent relapse
• set goals you want to reach in your social, emotional, physical and spiritual life.

Treatment

It is widely understood that people respond better to treatments for mental illness outside of hospitals in familiar surroundings.

Hospitalisation is only usually needed for people who need intensive help and support to manage their mental illness. The aim is to help people to return to their own environment with the right level of support to successfully manage their recovery.

The types of treatment a person receives while in hospital is tailored to meet individual needs and may include:

• help to manage activities of daily living e.g. personal hygiene, domestic tasks, budgeting, cooking
• support to address physical health problems
• therapies to manage psychological symptoms and emotional distress
• medication
• support to address any alcohol or drug problems
• education about the nature of mental illness
• support for families and carers
• discharge planning and the establishment of support to help you manage in the community.

Assessment and treatment under the Mental Health Act

In some cases, a person's mental illness may stop them from recognising that they require help or an admission to hospital. In these circumstances, it may be appropriate for the person to be assessed under the Mental Health Act 2000.

The purpose of an involuntary assessment under the Mental Health Act 2000 is to determine if the person requires treatment for a mental illness.

The involuntary assessment of a person may only be commenced if a request for assessment and a recommendation for assessment are both in place.

An adult who has observed the person in the last 3 days and believes the person may have a mental illness may make a request for assessment. However, a recommendation for assessment may only be made by a doctor or authorised mental health practitioner.

Once both these documents are in place, a person can be taken to an authorised mental health service by a health practitioner or an ambulance officer for assessment. While the person is at the authorised mental health service for the assessment, they are an ‘involuntary patient’.

At the end of the assessment period (which must not be longer than 72 hours), if the person meets the ‘treatment criteria’ of the Mental Health Act 2000, they may be placed on an involuntary treatment order.

On making an involuntary treatment order, the authorised doctor must specify the category of the order. The category may be ‘inpatient’ or ‘community’. This decision is based on whether the person needs to be admitted to the hospital for inpatient treatment, or can be effectively treated while living in the community.

If the patient is being treated as an inpatient, the authorised doctor can also authorise limited community treatment. Limited community treatment enables an inpatient to receive short periods of leave in the community. This process enables a process of transition before discharge from hospital.

Read more about how the Mental Health Act 2000 governs involuntary assessment and treatment, including patient rights and responsibilities.