Serious Q on when a doc can have you "committed."

Miscellaneous and Personal Stuff I Must Share
1

My apologies in advance if this belongs in GQ.

I’m going to be seeing my Psychiatrist (or psychologist, I can never remember the difference- he prescribes my meds, not counseling) tomorrow for the first time in about a year. I haven’t seen him for so long because I don’t have insurance. I’ve cut too far back on my meds due said lack of insurance.

I’ve not been well at all, and I know I should tell him everything that has been going on. But I’m afraid of telling him about my distrubing thoughts because I don’t want him to hold me against my will.

Now just hold on. Don’t think I’m going to do something dreadful. I have these thoughts but I’m too afraid of acting on them. I know I need therapy, and I’m going to ask for a referral to a free/ cheap counselor. I just need to know if he’s obligated to hold me for having these thoughts, or if the obligation comes into play only when one attempts to follow through.

Side note: The intention of my posting this is to know where the line is drawn for the professional. This is not a cry for help, a suicide note, or an “attempt at getting attention.” Please don’t take it as such, and please don’t take me to the Pit.

2

IANAD, I’m just a consumer, and the last time I’d faced involuntary admission I was in no position to contest it. However, IIRC, it’s very hard to committ someone who’s not showing obvious signs of being unable to deal with things as they are.

Thus, if you were to go in with cuts going up and down both arms, and admitted to suicidal thoughts, that may be reason for an involuntary admission. Saying you’ve thought about suicide, but don’t expect you’d ever act on it, isn’t (Again, to my recollection.) sufficient.

If you’re saying you’ve been having thoughts about harming someone else, that may be more likely to lead to an admission.

One thing to consider, however, is that by going to a doctor of your own free will, with a willingness to take medications to control your symptoms you’re already doing much that an involuntary admission could do for you. The rules are such that to begin an involuntary admission there has to be serious reason to believe you are a threat to yourself or others. And then after 96 hours, they have to have hard evidence to keep you. That standard is such that a patient going to a doctor, and seeking help, isn’t often committed.

Your doctor may suggest that going inpatient could have benefits for you, but that’s a very different thing.

My advice would be to tell your doctor that you’re afraid of being committed, because you can’t afford to lose work, and that while you’ve had some ‘bad’ thoughts, you’ve had no desire, or plans to act on them. Be upfront, and explain that’s part of why you’re looking for help.

Frankly, that’s a pretty rational sign right there, IMNSHO. Don’t worry about being committed, tell the truth, and get the help you need.

3

I don’t have anything to add, but I wanted to let you know that I’ll be thinking good thoughts for you and hoping you get all the help you need.

4

I’d go with what OtakuLoki said. Involuntary committal is usually for when you are deemed to be in imminent danger and lack the capacity to make an informed decision about treatment. Particularly if attempts to elicit a rational response that shows you have the ability to make rational decisions.

The criteria vary from state to state, but generally all four of the following must be met:

  1. You’re suffering from a mental illness.
  2. You lack that ability to make rational decisions hand show no signs of having that capability to rationally discuss your situation.
  3. You are likely to harm yourself, someone else, or damage property.
  4. Your diagnosis is not only one of the following: alcohol or chemical substance abuse; anti-social personality disorder; mental retardation; organic personality syndrome; or an organic mental disorder.

The fact that you are voicing concerns about how your insurance coverage is affecting your care and are looking for a more affordable therapist shows you are actively involved in your treatment process and are very rational about it. Acknowledging suicidal thoughts itself won’t get you involuntarily held unless you are also behaving in a manner that suggests you are likely to harm yourself or someone else.

Again it varies by juristiction, YMMV, but they generally don’t like involuntarily holding someone.

5

You would only get committed if it was decided that you were a danger to yourself and/or others.

Good luck in sorting things out.

6

Without knowing exactly what thoughts you’re having or what meds you’re supposed to be taking (but not taking because of money issues) and without any kind of professional psychological experience, here’s what I’ve seen.

If there is no threat of you actually hurting yourself or others, then he’s not going to hold you. It’s your option to accept any treatment and/or any medications. As long as you are aware of the consequences of not taking the medication or accepting treatment, and as long as you’re not a danger or in danger, then anything you do is voluntary. It’s like if you’re in a hospital and someone says “You need to have this shot or you’ll die tomorrow”. You can completely refuse it, provided they feel you understand the consequences.
If you’re incapacitated or not thinking straight or something, then they’ll give it to you anyway.

7

So my official MPSIMS advice is this:

Tell him all your thoughts. Tell him the conflicts you’re having. Tell him specific times you’ve had these thoughts and how – despite the mental turmoil – you’ve never acted on them. And you know you would never act on these feelings/emotions or whatever they are. Tell him how you are struggling but you’re in control.

Tell him that you really would like help, and you know you need help. But that you can’t afford his help or his meds. And ask him if he knows of any alternatives.

He’s a psych so I’m pretty positive he will know if there are things you’re not telling him! Don’t try to conceal anything. Be open and honest. Show him that you want help, but you can’t afford it.
And make sure he knows you haven’t been on your meds because of money issues. If he thinks you’re not taking them because you don’t have the capacity or stability to take your medication, things might turn out unpleasantly. But even then, you’re still in the clear provided no one could get hurt.

A safe senile person is usually left alone. No one can force her to take the meds.

8

Having thoughts of suicide with no intention of acting on them is common in such cases. Psychiatrists know this, and know that most people who say they aren’t going to act on such thoughts won’t. If they incarcerated everybody who told them about such things, they’d become very unpopular with the hospital management :wink:

9

I hope to not scare you off from talking about your feelings, because you should, but if they do decide to put you on an involuntairy hold, don’t freak out over it…

I frequently will take patients to the ER with depression or suicidal ideas. For some hospitals it is an automatic hold of up to 72 hours at that point (in NV). Now, during that time you are seen by an ER doc to ensure there is no medical explination for your feelings, and then see by a psych doc. Together you and the psych doc figure out what is best, and people are generally let go for outpatient treatment(hopefully in less than 72 hrs). If they want to keep you for any longer than 72 hours a court order is necessary.

10

That and they’d never get any meds working properly. You’re supposed to inform your doctor of any suicidal thoughts or preoccupation with death because it may be a sign that you’re having a negative rection to mediation, or discontinuing a medication, if you’re being switched form on to another, etc.

A dialog about suicidal thoughts is pretty regular in most therapist-patient relationships. Committal criteria only come into play when there is imminent danger or if the patient appears to have impaired judgement. For example, you are allowed to refuse any treament without fear of involuntary admission as long as to are maintaining a rational, and logical thought process and ability to communicate it.

If you say “I have been entertaining suicidal thoughts, but I have concerns about the financial burden hosptalization will put on me and my family and I would prefer an alternative such as weekly therapy and/or community support groups. Can you refer me to a therapist who has a sliding-scale for fees?” – THAT is a rational opinion about your wishes and preferences for treatment.

If you say “I’ve been thinking aobut killing myself, but I don’t want to go to the hospital because they will put microchips in my forehead. And I think the orderlies are trying to poison me.” – Then your ability to rationally discuss your treatment is in question.

The four criteria I mentioned above are also very similar to those in the Mental Health Act (Canada), and an important thing to note is that you have to meet ALL four. In a time of crisis, where you may be in imminent danger, they may keep you in the hospital overnight, but it’s really not that easy to get committed involuntarily if you are still speaking coherently with the obvious ability for rational decision-making.

11

I think you’ve gotten some good advice in this thread. But I understand your concern. Suicidal thoughts are (not really unreasonably) one of the things that sends up a red flag for psychitrists. It has to.

I think it depends a lot on what kind of realtionship you have with your psychiatrist (and if he prescribes meds he’s a psychiatrist not a psychologist…I can’t tell you how to remember the difference, I only remember because my mother’s one :D).

I agree you need to be honest about how you’ve been feeling. All the more with someone whose prescribing medication. But you might want to emphasis that you have done nothing to act on these thought. And (and I hope this is the case for you :)) any support system you have going for you. Friends, family. That will do much to reassure a psychiatrist who’s worried about you.

12

Thanks for the advice and good thoughts. I’ll do my best to describe to him how I feel.

This sucks.

13

Doc’s appointment:

  1. Had my best friend drive me out there & go in and talk to the doc with me. All went well.
  2. I didn’t realize that my last visit was in Aug of 2003. We told the doc what has been going on. Told him about quitting my good-paying job at the power company because I was having panic attacks every morning before I went in. Told him that my depressed moods are more severe, and I get pissed off too easily. Told him that nothing has to happen for my moods to go in the other direction in quick time, and that when something does happen, it affects me more profoundly than everyone else. Best friend gave the example of showing me some “Black Americana” junk on Ebay (you know, mammy cookie jars and magnets) and I got so offended and pissed off that I went ballistic.
  3. I told Doc that it seemed that none of the anti depressants I’d tried have ever made me feel what I would consider “normal.” He said we could try a mood stabilizer. I immediately thanked him profusely (because hey, mood stabilizer sounds like just what I need) in my weird, over-animated way. :rolleyes: I hate it when I do that. He said he’d write a prescription and give me a sample pack of Lamictal. I asked if it was generic (due to money problems) and he said no, but we could try Lithium.
  4. “Uh, isn’t that used to treat Bi Polar disorder?” I asked. He said that yes, it was but he would consider me to be atypical bi polar. Whatever that means… I had suspected as much for a couple years. Anyway, this doesn’t bother me. I just want some fucking relief. He gave me samples and explicit instructions on dosage, and what to watch for as far as toxicity goes. I’m to start out super low (450 mg) for 4 days, if I don’t see a difference up it to 900 mg. If that doesn’t work, we’d consider the other drug. I am to call him in 1 week to give an update. If I have any problems, I am to stop meds and call immediately.
  5. Told him that I need counseling, but I can’t afford it. He gave two suggestions on cheap/free counseling: Catholic Charities & Community Mental Health. Told me to call Catholic Charities first because in his experience, they seem to be more caring and not as burned out. He also mentioned that I might want to consider applying for disability.
  6. Left feeling hopeful that there is a light at the end of the tunnel, and in reasonably good spirits.
    Called Catholic Charities a half hour ago:
  7. “Donna” answered the phone. I explained that I had just come from an appointment with my Psychiatrist & he suggested I give them a call.
  8. She proceeded to rip me a new asshole because she takes issue with how psychiatrists prescribe all these potentially harmful drugs and don’t bother to take even thirty minutes to do any counselling.
  9. She’s very aggressive and rude when asking me about my income. Asks me accusingly how I paid for my meds and psych appointment if I didn’t have a job.
  10. Bitches even more about how psychiatrists are irresponsible louts because they don’t provide counselling.
  11. I feel the need to defend myself (if not my doc) and tell her that when I started seeing him, I was indeed in counselling, but I quit because my therapist wasn’t a good fit for me.
  12. She asks what meds I’m taking. I explain that I had tried many different anti depressants, and that they didn’t make a difference for me, so I had just been prescribed Eskalith. I purposely didn’t say “lithium” because I feared another tirade due to the risks of toxicity. Had to fucking spell Eskalith for her because she wasn’t familiar with it.
  13. She said that she could only get me in for a couple therapy sessions, because they just “don’t do” any kind of long-term therapy.
  14. She then said that she was going to ask for some information and I said, “You know, I’m already having second thoughts. Thank you for your time.” And I hung up.
    I immediately called my doc’s office and left a voice mail for his assistant, crying my eyes out. I said that I had just got off the phone with Donna at Catholic Charities and explained in graffic detail about my conversation with her. I was sobbing and croaking my words out. I also said that it would be a good idea if he didn’t refer any of his patients to CC again because that lady was such a fucking bitch.

I’ve quit crying now. I’m so embarrassed. I’m sure I sounded like a loon.

Fuck counselling.

14

You don’t sound like a loon. You sound like someone who is really upset and distressed by the lack of concern and compassion you’ve received from a reputed source of help. You wanted relief and instead you got veiled accusations. It is discouraging just to read your reiteration of it; I can only imagine what it must have been like in first person.

You might try calling again and asking for someone other than “Donna”, or contact CMH. There may be other resources as well; ask your doctor again.

Hang in there.

Stranger

15

Holy crap! “Donna” sounds like she ought to be on medcation herself (if she’s that hostile, she may be volunteerig in peer counseling kind of way, so I’m not actually joking.)

Keep looking. I found a wonderful therapist who works on a sliding-scale for fees. She bases it on income and suggests a range. If my income was god, I’d pay the high end, if it was crap, I’d pay the low end. You may be able to find other support groups too, and while they aren’t a replacement for therapy, they can do a lot to bolster your confidence with respect to just being able to talk about your moods without worrying about judgement or social embarassment or anything.

Lithium actually has several other applications. It is a tried and true method to treat bipolar disorder true, but it’s also used to treat a variety of other mood disorders. It tackles mania and hypomania well, and it’s often used for Boderline Personality Order which a condition that makes a person prone to anxiety attacks and outbursts of anger and rage. It still improves depression too.

It doesn’t have a sedative affect so won’ make you dopey. But BE WARNED do not suddenly stop taking it. It a kind of medication that can have dramatically good results, but if you suddnely stop taking it, in the following weeks you can crash and feel 20 times as bad! So be sure you stay in touch with your doc if you need to stop taking it.

16

Hi,
I just wanted to tell you that I hope things work out for you, and give you support.

Also, I think this is a perfect example of why we need to fucking fix health care in this country. This is fucking bullshit. Sorry for the hijack, but it really makes me angry after hearing your story (At the system, not at you of course :wink: )

17

Please give counseling another try. Donnas show up everywhere (even where they really, really shouldn’t), but your chances of running into another one are slim. Most of us in the mental health field are pretty kind folks.

You did great to be so honest with your psychiatrist! I hope you can take pride in that.

18

Hi Seeker, I just wanted to say I had a very similar experience when I was trying to find a good counsellor. I eventually found a psych at my university who was amazing, and never once made me feel like the drugs I were taking were a crutch for the weak. She explained it to me like this: Therapy is very helpful, but you cannot begin to treat behavioural issues until you stabilize the underlying brain chemistry problem. Take some time to collect yourself, and then try for another therapist.

I’m going through a real rough patch here myself, and I think I can empathize with where you are coming from. This sucks, it truly does.

19

Thank you for all the encouragement. I can’t tell you how much it’s appreciated. My husband and my two close friends are very supportive, but Mom isn’t. Last night, she told me “not to get on any drugs I don’t really need…” :rolleyes: So when she asked about my appointment tonight, I just told her I didn’t want to discuss it. Seems like one detractor can cancel out the good guys. One step forward, two steps back.

I just took my first lithium a little while ago. Let the games begin… I still took my trazodone, at my doc’s request. He told me that if I feel the same tomorrow, I can try not taking the traz. That sounded flip-flopped to me, but he’s the professional. :shrug:

Eats_crayons: In your experience, will benadryl or asprin jack me up? That’s part of my Nightly Cocktail, and I can’t remember if he’s got those on my regular med list. I’m thinking that they won’t really matter, but I’ll call and confirm tomorrow if you think I should.

Goin’ to bed now. I’m pooped. Nighty night.

20

Any damn time he wants to. If he prescribes your meds, he’s a psychiatrist, and psychiatrists can commit, and they don’t have to justify their reasoning to anyone.

(In most states, a corroborating opinion is required at the psychiatric center to which you would be taken, but it’s pro forma in most cases. You do have rights during your stay, and rights to contest being found to be a danger to yourself and/or others if the institution decides to seke to retain you. But they can hold you for an annoyingly lengthy evaluation period just to determine for themselves whether or not to pursue commitment, and you have no right to contest being held during this interval)