Borderline personality disorder (BPD) is a serious condition that sometimes requires intensive inpatient treatment at a psychiatric hospital. The idea of being hospitalized is very frightening for most people, but knowing what to expect can reduce your anxiety.
Duration of Inpatient TreatmentIn the past, inpatient treatment for BPD may have lasted months or even years, but now inpatient treatment is generally much shorter, depending on the needs of the patient. Most inpatient hospitalizations occur due to concern that the patient may be at risk of harming herself or someone else, and the patient is discharged once that risk has passed. Some hospitals do offer longer-term, voluntary intensive treatments for BPD, which may last for weeks or months. In general, however, research has shown that very long psychiatric hospitalizations are not helpful for people with BPD.
Voluntary Versus Involuntary Inpatient Treatment
A psychiatric inpatient hospitalization may occur voluntarily or involuntarily. A voluntary hospitalization occurs when the patient recognizes that he is in need of more help than can be provided through outpatient treatment. For example, he may recognize that he is having a period of very strong symptoms that he cannot handle on his own, and that he needs more than once or twice a week therapy to keep himself safe. In this case, the patient and the therapist may decide together that inpatient treatment is best.
An involuntary hospitalization occurs when the patient is not willing to be admitted to the hospital, but the treatment providers have deemed this level of care necessary. For example, if someone is expressing intent to commit suicide, but refuses to be hospitalized for safety, her treatment providers are required to pursue involuntary hospitalization (also called “commitment”).
What to Expect During Inpatient Treatment
What should you expect if you are going for inpatient treatment? This varies depending on the hospital and the treatment program. In most cases, the purpose of inpatient hospitalization is to provide a safe environment for stabilization in the case of a mental health crisis. Usually you will be provided with some individual or group psychotherapy, as well as medication management. Once stabilization has been achieved, you will be discharged either to a partial psychiatric hospital program or to outpatient treatment.
There are also longer-term inpatient hospital programs that focus on providing more comprehensive treatment. Rather than just focusing on stabilization, these programs may provide intensive psychotherapy (such as dialectical behavior therapy), and may last for a few weeks or months. These longer-term programs are generally voluntary, and may include group, individual and family therapy.
Paying for Inpatient Treatment
Who will pay for your inpatient treatment? This depends on a lot of factors. If you have insurance, they may cover the bill. If not, Medicare, Medicaid or your state’s department of mental health may cover the bill. Some programs are very expensive and are rarely covered by insurance. If, like most people, you are worried about the cost, talk to your health insurance company or contact your state’s public health insurance program.
How to Find Inpatient Treatment for BPD
If you think you may need to be admitted to an inpatient treatment program (or you believe a loved one may need this type of program), the best place to start is to ask your or your loved one’s current therapist or psychiatrist about a potential referral. Most inpatient treatment facilities accept patients only through referrals or in cases of emergencies. For voluntary treatment, there may be a waitlist to get into a specialized program, so keep this in mind and start your search early.
If you or a loved one is in a mental health crisis (you are actively suicidal or homicidal, for example), call 911 or go to you nearest emergency room (see also "What To Do In A Crisis"). If the mental health staff at the hospital feel that inpatient treatment is necessary, you will either be transferred to the psychiatric unit of the hospital. If there is no psychiatric unit, you may be transported to a different hospital with a psychiatric program.
Practice guideline for the treatment of patients with borderline personality disorder. American Journal of Psychiatry, 158:1-52, 2001.