Hospitalization is the highest level of treatment. It is reserved for the most severe forms of depression (as well as other mental disorders). One criterion used for determining the necessity of hospitalization is the presence of suicidality. Having suicidal ideation does not automatically dictate a hospital stay but prompts an inquiry into the patient’s level of risk to harm one-self (or others). Hospitalization may also be indicated if a person’s functional impairment is so poor that he or she is unable to care adequately for himself or her-self (e.g., unable to get out of bed and not eating).
Most often, depressed individuals are willing to be hospitalized if recommended and thus do so voluntarily. Situations exist, however, when the physician believes hospitalization is necessary but the patient refuses. The physician then needs to decide whether the person should be admitted involuntarily. Criteria for involuntary admission vary from state to state, but it is generally not easy to admit someone against his or her will. Most states have mental hygiene laws in place to protect patient’s rights. Typically, dangerousness to self or others is the criterion required to commit some-one. Usually, an appeal process is available to such a patient as well.