Dear Patti, 
Last night, my brother and his wife delivered the bombshell that our dad (72) isn’t doing well mentally and they are trying to get him to voluntarily consider hospitalization. Although I love my dad and visit him sporadically, we don’t get along that well, and so I’ve let my brother handle most of his affairs and keep me posted on the state of his health. According to my brother’s reports, my father has been steadily deteriorating emotionally, and both his psychiatrist and internist are seriously considering involuntary hospitalization if dad is unwilling to go on his own. What is involved in hospitalization for a serious psychological problem? Why might it be better than outpatient treatment? 
 
How do we know if involuntary hospitalization is the right decision? 
 
I must admit I’m torn and feel guilty that I’m not supportive enough, but I’m afraid of getting too close and being hurt again — Lindy
Dear Lindy,
Hospitalization should be considered when outpatient interventions aren’t sufficient and your dad is no longer capable of overcoming serious psychological stressors without more intensive forms of treatment. Hospitalization should also be considered if he has limited psychosocial resources on which to depend. If, for example, he’s psychotic, acutely suicidal, homicidal or gravely disabled, hospitalization is often a necessary step in stabilizing him.
 
If your father’s doctors and your family want to support him in voluntarily entering hospital treatment, and if he is coherent and rational enough to understand, you may all want to sit down with him and provide concrete reasons supporting the opinion that such steps are necessary at this time. Have his doctors address any potential fears by explaining what he can expect, the specific goals of the treatment program (i.e., mood and symptom stabilization, medication), and a projected timeframe (generally a minimum stay of two weeks). The doctors can also help dispel misconceptions or stereotypes that he may have regarding inpatient mental health treatment.
 
When your father is hospitalized, it’s OK to be assertive and make sure he’s receiving the best possible care. It’s also important to remember that inpatient care requires conscientious outpatient care following hospitalization. He may very well need emotional support from all of you.
 
In order to be involuntarily hospitalized, specific behaviors need to be exhibited by the patient. In addition to a legal hearing wherein the length of a stay is determined by medical staff recommendations, the evaluation criteria must be based on a mental disorder in one of the following three categories.
 
The first of these is grave disability and relates to the individual’s inability to provide for his basic needs of food, clothing and shelter as a result of mental incapacitation. It is also considered grave danger if someone has a potentially life-threatening medical condition and will not seek appropriate medical treatment. 
 
The second category is when someone is considered a danger to others and has indicated in words or actions an intention to cause bodily harm to another person. These threats are specific to a particular individual, the way he’d do harm is described and the way he’d get to the victim is also identified. Additional behaviors include engaging or intending to engage in actions of an irrational, impulsive or reckless nature such as destruction of property or misuse of a vehicle as to put others directly in danger. 
The third category is danger to one’s self and manifests in words and actions that express a desire to commit suicide or inflict personal bodily harm or injury.
 
I’m sorry that your father is struggling so and sincerely hope you’re able to get excellent help for him. It’s clear that you’re deeply affected by this unsettling news of his illness and it can often be challenging to know how to handle such a situation when you have such strong, ambivalent feelings toward him. You may feel overwhelmed at times with helplessness, anger, guilt, shame and grief. Not only is this OK, but it is actually normal under the circumstances. Even if you have already gone through psychotherapy concerning your strained relationship, you may want additional counseling. Try to be as loving and supportive of him as possible, but also stay true to yourself and take into consideration your own feelings and needs. Make sure the ones who love and support you are close by to listen. Your father may very well recover, but it will probably happen slowly. In order to support your dad, you will need nurturing, comfort and understanding as well. 

Patti Carmalt-Vener, a faculty member with the Southern California Society for Intensive Short Term Psychotherapy, has been a psychotherapist in private practice for 23 years and has offices in Pasadena, Santa Monica and Canoga Park. Contact her at (626) 584-8582 or email pcarmalt@aol.com. Visit her Web site: patticarmalt-vener.com.