I've been voluntary every time I've gone in (5) but 4/5 times my pdoc arranged the admission and I didn't have to go to the ER. The time I did go to the ER I had a long wait (30 hours) for a bed but it was just an unusually busy weekend and there were no psych beds in the city. That time when I went in a nurse asked me some questions, an ER doctor asked me a few more and I explained how unsafe I felt, he told me they could help me and that was it. I'm sure if I had decided to leave in those 30 hours I would have been put on involuntary but I wasn't about to start over on the waitlist and I knew I really needed admitted anyway.

I go 2.5 hours away to go to a good hospital. I may drive past a perfectly good place on the way but my hospital has a mood disorder unit and since my pdoc is on staff there she stays involved with my meds and I never leave on some cocktail she has to fix later. Occasionally I even get to see her if she is on call. Neither insurance nor Medicare have cared where I went; I think that would only matter if you had an HMO.

The place I go is nice. It is locked and you have to give up electronics and there is no outdoor time but it is fairly quiet (only 10 patients, generally 9/10 are depressed while I annoy them with mania). It is a mood disorder unit so the groups are all aimed at mood issues. They have a computer, TV, Wii Fit and stationary bike on the unit and keep some craft supplies/coloring stuff out all the time. There are also cabinets with games and puzzles.

They don't do individual therapy but have let me do phone sessions with my own therapist in the past and let me sit in a conference room to do them.

I feel safe there and while going back isn't something I hope for I know that if i have to it will be fine. Aside from one nurse and a social worker who are both gone now everyone has been consistently kind and I have always felt well-taken care of.

Getting admitted to Duke might get you into the pdoc there sooner since they generally hook you up with an appointment with your pdoc soon after discharge and if you are in the Duke system that would probably be considered your doctor.