What Happens During a Psychiatric Hospitalization in Massachusetts

When people hear “psychiatric hospitalization,” their minds often jump to dramatic images—patients locked away indefinitely or scenes that resemble punishment more than care. As an adult inpatient psychiatrist working in the public sector in Massachusetts, I want to offer a more grounded and accurate perspective—one that reflects both the reality of the system and the humanity of the people within it.

Psychiatric Hospitals Are Places for Stabilization, Not Isolation

A psychiatric hospitalization is not meant to “lock someone up.” It’s a short-term intervention aimed at stabilizing someone in the midst of a psychiatric or substance use crisis. The most common reasons adults are hospitalized in Massachusetts include suicidal thoughts and severe psychotic disorders that place the person—or others—at risk of harm. It’s one step in a much longer journey toward healing, not a one-size-fits-all solution.

How People Are Hospitalized in Massachusetts

There are many paths that lead to psychiatric hospitalization. In Massachusetts, many adults arrive under a “Section 12”—a legal statute that allows for involuntary hospitalization for up to three business days (excluding weekends and holidays) if someone is at risk of serious harm due to their mental health. These holds can be initiated by police officers, physicians, psychologists, licensed social workers, or nurse practitioners.

Sometimes patients are brought in during a sudden crisis—others may be referred by outpatient providers who are concerned about a person’s safety. Family members can also petition the court for an evaluation. Not all admissions are involuntary; many people arrive voluntarily and sign what’s called a “conditional voluntary” form. Even voluntary patients can request to leave, but the hospital may require a “3-day notice” to ensure it’s clinically safe and appropriate.

Are Patients Forced to Take Medication?

One of the most common fears about psychiatric hospitalization is the concern about being medicated against your will. In Massachusetts, medications are not given involuntarily unless a person poses an immediate risk of harm to themselves or others. In these situations, a psychiatrist may use what’s called a medication restraint—an emergency intervention to prevent serious harm.

However, there are longer-term legal processes that may also result in court-authorized treatment. If someone is under a civil commitment or a Roger’s order—a legal mechanism where a judge determines that someone lacks the capacity to make decisions about their psychiatric care—they may be required to take medications even if they object. These decisions are not made lightly and involve careful legal and clinical review. Even then, the person has the right to legal representation and due process.

What Happens During the First Few Days

Once admitted, patients are typically evaluated by a psychiatrist or nurse practitioner within 24 to 48 hours. This initial assessment helps clarify the diagnosis and lay the foundation for a treatment plan. But care doesn’t stop there. Patients also meet with social workers, nurses, occupational therapists, and milieu counselors who all work together to support the person’s care and eventual discharge.

Contrary to popular belief, medications are not always started right away. If a person arrives in crisis, or if their medication history is unclear, it may take time to confirm the right medication and dose with a pharmacy or prior provider. During those first few days, the team may also reach out to family members or outpatient clinicians to get a fuller picture of the person’s mental health history.

Treatment Is Structured, Not Static

While each facility differs, most offer group therapies, psychoeducation, and skill-building activities focused on emotional regulation and coping. One-on-one sessions and team meetings are common. Treatment is collaborative—and it’s not just about prescribing medications, but helping people regain a sense of control and dignity.

The length of stay can vary. Some people stay only a few days. Others stay longer, especially if there are barriers like homelessness, substance use complications, or the need for transfer to a step-down facility like a Community Crisis Stabilization (CCS) unit.

There may be restrictions on personal technology

In the same vein, facilities may differ on their policies regarding using your own technology such as cell phones and tablets. The staff will typically let you know upon arrival about the policies surrounding cell phone use and other personal technology. Some facilities may be more restrictive then others in which you can’t use your cell at all (unless to retrieve phone numbers or important messages). Oftentimes this is related to privacy to prevent photos or videos being taken of other patients.

The Challenge of Discharge and Aftercare

Leaving the hospital isn’t the end—it’s the beginning of the next phase of recovery. A social worker or case manager typically helps coordinate outpatient follow-up, but patients may still face serious challenges: difficulty accessing medications, missed appointments, or returning to a stressful environment with little support.

These challenges are even more complex in the public sector. Housing instability, insurance gaps, and long waitlists for outpatient care can all undermine the stability achieved during hospitalization. And unfortunately, a psychiatric facility—on its own—cannot fix systemic issues like homelessness, trauma, or chronic poverty.

Psychiatric Hospitalization in Context

I hope more people understood that psychiatric hospitals are not designed to be long-term solutions—and that patients are not criminals or broken people. They’re human beings in crisis, deserving of respect, dignity, and continuity of care.

There are also system-wide pressures: bed shortages, especially during the COVID-19 pandemic, which caused emergency departments across Massachusetts to overflow with patients waiting days—or even weeks—for a psychiatric bed. Medication availability may be limited. Insurance often dictates how long someone can stay. These realities weigh heavily on both patients and providers.

Final Thoughts

If you or someone you love ever needs psychiatric hospitalization, I want you to know this: getting help is not shameful nor is it a failure. It is a step toward stability. A step toward reclaiming your health, your clarity, your life. Hospitals may not solve everything—but they are a place to begin treatment. If you or a loved one is an a psychiatric hospital you should feel empowered to ask questions about your rights and the policies of the facility.

For more information on your rights regarding admission and discharge from a psychiatric hospital in Massachusetts refer to this document by the Mental Health Legal Advisors Committee.