Do people still have themselves committed into mental institutions? Does the institution automatically accept the person? How disfunctional does a person have to be, in order to be admitted? And once admitted, what would a typical day be like for them?
Yes, people can committ themselves to psychiatric hospitals. The hospital does not automatically accept the person. There is a lengthy assessment process where a treatment team decides what would be the best way to treat the individual (they also check out your insurance!). You have to fill out a bunch of paperwork, they read over any documentation you might have on yourself, and you get interviewed by different people. It can take up to 4 or 5 hours. The treatment team will decide if you are dysfunctional enough to need inpatient treatment, it varies. In general, if you are a danger to self or others, or are actively psychotic, and you got good insurance, you are in! A typical day depends on the hospital and the treatment. In drug rehab you have a regimented day with lots of group therapy, 12 step meetings and individual therapy. In the psychiatric wing, you have much more free time, you play boardgames, read, watch tv, and you eat a lot of ice cream.
These are my experiences as a person in the mental health field, YMMV.
Here is a good link: American Psychiatric Association
A good portion of the time, when your behaviors have brought you directly or indirectly to the worried attention of the mental health professionals, you will be asked to consider voluntarily agreeing to treatment.
If it’s your idea from the outset, they don’t have to take you; if they become convinced that you need psychiatric help, though, they generally will.
This is sometimes expressed misleadingly as “If you’ll just sign the form, it says that you agree to talk to the doctor, and if the doctor says you’re OK you can go home”, without mentioning that one’s first opportunity to talk to the doctor may be 3 days’ hence or that you’re consenting to be held behind locked doors and can’t simply say “screw this” and walk out if you don’t like what happens next.
As a voluntary patient, you issue a 72-hour (3-day) notice of intent to leave, and during those three days the institution can make arrangements to have a hearing to commit you involuntarily. They can also simply try to talk you out of it and ask you to rescind your 72-hour notice. Or they can let you know that your behavior, consisting of doing self-destructive things like trying to sign out of the place, indicates a worsening of your mental condition that may constitute a psychiatric emergency, which in turn would require injecting you with strong drugs and/or straitjacketing your and/or placing you in seclusion, but that the doctor would see your rescinding of your 72-hour notice as an encouraging sign that would fend off such worries.
Different institutions function differently. The first time I signed the stupid piece of paper, I was soon having staff demand that I turn over to them my shoelaces and my belt and I was placed on the acutely disordered wing because it was their policy to start all newly admitted people out on that ward. (Thus you get rewarded for “improving” by being moved to more humane quarters and the opportunity to associate with people more of whom you can converse with coherently).
The second time (don’t look at me that way, I can’t believe it myself, but I had my parents and a dozen other people swearing up and down that the first bin was an atypical throwback snakepit), people were warm and friendly and took me around on orientation, and the other patients played a very active role in this; rather than trying to intimidate me with the horrors I’d be exposed to until/unless I “got better”, everyone spoke earnestly about how my thinking would change and what I would soon come to realize about myself and how good this place was going to be for me. They spoke so earnestly and at such great length that I did not get a word in edgewise for my first 48 hours, in fact. When I did, and eventually voiced some opinions or perspectives not in keeping with what they wished me to express and think, they became very disappointed and told me so and alternately shunned me and sympathetically encouraged me to express “right thinking” so we could all have a good time, and eventually told me with some anger that my failure to get with the program was having a negative impact on other patients’ well-being.
If the institution chooses to pursue an involuntary on you after you have issued a 72-hour notice, you are entitled to appear at the commitment hearing and you are entitled to representation which is usually provided through your state’s equivalent of Mental Hygiene Legal Services (the NY name), although I would assume you can instead retain counsel of your own choosing, if you can gain access to a telephone to make the arrangements (no guarantee of that). The MHLS counsel may be an advocate for patients’ rights and self-determination (as they are supposed to be) but may instead be a person who believes that the doctor knows what’s best for you and tries to talk you out of pursuing the matter, and/or who does not pursue an actively adversarial defense of your case in the face of the institution’s case for retaining you involuntarily. The judge similarly may be a reasonably impartial party who listens to both sides and rules on the evidence (including the evidence of how you present yourself on the stand in the courtroom) or may believe that the doctors are experts and that the hearing should always just be a formality (i.e., they aren’t going to side with a mentally ill person against the doctor who knows what you need). And the courtroom may resemble other courtrooms you’ve seen in real live or on TV or it may be a little alcove right there on the locked ward, and you may be brought in in a hospital gown or even a straitjacket, and you may or may not be allowed to even speak. (And they may or may not find it necessary for some reason to shoot you full of haldol or prolixin an hour and a half before the hearing if you were to pose a behavioral problem, act out in a fashion that indicated elevated risk of violence, etc.).
Oh, and, as was pointed out to me by the head shrink at the second of the two above-described institutions, the psychiatrist may golf regularly with the judge and dine with the judge’s family and vice versa.
If they decide to retain you involuntarily, the order to do so expires after a mere 60 days and then if they still wish to retain you against your wishes they have to bring you into the courtroom again.
What would it do to an already damaged pysche to be judged too sane? 