I encourage you to do some research around the mental health system in 2013. Patient centered care in the least restrictive environment, conducted briefly, and with measurable outcomes, and emphasis of quality services (with quantity less of a factor–many good or few good), is where this field is moving. Gone are the days of long term lockups at the hands of Nurse Ratchett. Patients and their systems are active participants across all aspects of care.
I’m telling you this because I live this, day in and out. Your experience is limited and outdated. In many ways, continuing to argue this perspective of patient as victim is more destructive than not. You are spreading information based on the way things were…versus how they are now. How is that compassionate and caring?
That is truly good to hear. I have seen many of these improvements myself, and hope the improvements continue.
That is a pretty nasty way to make an argument, don’t you think? I’d be able to give a response to the real question you have here (maybe something like, “how can you continue to argue for your position?”) if it weren’t so loaded and argumentative.
I do take pride in my work. And I don’t attach my name to crap work. I also know that some people phone it in. Same as any job. I know this.
That said, I gave you facts. Of a procedure and process. There was little in there that had to do with my work values or ethics. Most of it was to provide a broader understanding for those in this thread regarding the complexities of admitting someone to an inpatient psychiatric unit.
I was not part of the OPs coworkers admission. But I do know that in order for someone to get “admitted against their will” is far from simple. It is not, as AHunter claims, a couple of evil blind shrinks deciding by way of paper communication to admit someone lickity split. It is far from that. In a time where healthcare is pricy and stretched thin, it is the exact opposite. Everything I wrote about the assessment process, without even considering my biases, supports NOT admitting people unless absolutely necessary.
If I were asked to provide an example of what “living in hell”, the phrase, means to me, the situation that comes to mind would be:
• locked up in an environment I can’t get out of
• at the mercy of the coercive attempts of other people (well-meaning or otherwise) to make me change my feelings and thoughts
• which are defined as meaningless static, symptoms of an illness rather than the outcome of my own beliefs and ideas
• with no regular access to allies or impartial disinterested 3rd parties
• with my own opinions and feelings on the matter included in the set of things regarded as among the symptoms
• where in addition to being able to keep me there indefinitely, arbitrarily create new rules concerning what I may or may not do and enforce them, and thus control most of my overall experience of being rewarded and punished, the people running it are even allowed to force drugs on me that mess with the way my brain functions, or to subject me to other intrusive treatments specifically designed to mess with my brain
Having said that, I do understand that it is painful and difficult to try to act in the best interests of the people involved, navigating the labyrinth of laws, availabilities, and other considerations delineated by living_in_hell above.
I fully accept that many professionals are trying to do their best and that it’s an emotionally frustrating and exhausting process. I also sympathize with family members who want what is best for their crazy loved ones, about whom they are profoundly worried as well as with whom they are at their own wit’s end trying to cope with the aggressively disruptive behaviors.
But some things are absolute for me. I don’t care how well-intended your motivations may be, it is morally wrong to coerce people in such invasive ways. I think the world is overall a better place if we let some unfortunate people slip through the cracks and suffer badly from their own inability to keep themselves out of harm, in order to avoid incarcerating people for theoretically being a danger to themselves. Likewise, we already have a criminal justice system for addressing the possibility of someone being a danger to others, and it works like this: if someone actually does do violence, we arrest and charge them with having done what they did, we go into court and lay out the evidence, and a jury that is charged with being impartial and with presuming innocence until evidence beyond a reasonable doubt leads them to conclude that the defendant really did do it, and then they can be taken out of circulation for the protection of the rest of us. We don’t arrange ways to apprehend and incarcerate people for things we think they might do, no matter how reasonable our suspicions of their likely behavior. Our system doesn’t permit it.
So: just don’t do it. Stop involuntary psychiatric treatment. All of it, period, end of story. That will make the clinical difficulties of operating such facilities a lot easier.
You can talk (or post) until you’re blue in the face about how it’s just not gonna happen that someone ends up locked up without a really really compellingly good reason. I do know otherwise. I’ve been in a huge auditorium full of people with a personal history of being on the receiving end of coercive psychiatry, I’ve seen it done at close range to people I know and been in the courtrooms and hospital corridors, and I’ve been subject to it once or twice myself. How small a percentage we represent is irrelevant: that it happens often enough to fill a room that size with people despite the stigma and the fear of being open about it and despite the costs associated with travel and so forth means it happens too damn often.
living_in_hell was inspired by my life at that time: my obnoxious neighbor. Also, by my coworker who was in favor of long term, problem focused, drugged up treatment. Yah. I worked with that guy. Hated him. Go figure.
So let me get this straight. In the example I gave earlier–setting small fires in the name of the second coming of Christ. When someone hears voices telling him to burn writings on napkins and curtains. When that person is placing innocent people at risk due to delusions and hallucinations. There is no reason to take action? Or because it’s technically “arson,” that it makes sense to put this person in the legal system–stand trial, and then jail or prison…rather than get attempt to get him help in a therapeutic manner?
I just want to be clear I am understanding your perspective.
I thanked you, and again thank you, for your detailed, thoughtful post outlining the processes you go through when placing psychiatric patients. I think the word “bias” has different connotations for you and I - yes, you were simply detailing the processes in a factual manner, but from my perspective, considering the context of this thread, your bias, your unspoken assumptions regarding that process, were also clear. I admit my bias, and, at the risk of being patronizing again, I believe that your arguments would be better if you were better able to understand yours - noting that “bias”, for me, does not have strongly negative connotations.
I understand that you were not involved in the OP’s coworker’s admission. I understand, better now thanks to your contributions to this thread, that the process of admission is not simple. I understand that your characterization of AHunter3’s position is marred by your distaste for his position. I understand that it is not very likely that someone would be needlessly placed (by the standards currently in place) on a psychiatric hold, and further that it has not yet been shown by anyone that profit motive comes strongly into play here.
Nevertheless, I am of the belief that, sometimes (hopefully increasingly rarely), people are placed on a psychiatric hold without sufficient reason (even by our current standards), and further, that sometimes people are mistreated by the system we have in place (via incompetence, malice, or the like), and further, that our current system - despite how difficult it can be to place someone on a psychiatric hold - is in need of reform in order to protect innocent people from improper incarceration and psychiatric harm (i.e. psychotropic medication that has strong side effects and are, for the people in question, inappropriately prescribed, such as sedatives or antipsychotics to manage behavior and increase compliance rather than for the benefit of the patient).
Further, involuntary psychiatric commitment can be devastatingly traumatic, even for people who arguably are in a position to warrant such treatment. When someone can reasonably say that they were not “saved” by such treatment, but can instead only point to the harm that was caused by the incarceration, the medication, the emotional damage, and the stigma - the trauma caused is severe indeed. In my view, it is absolutely incumbent upon us as a society to reduce as much as possible this kind of injustice and harm.
There are undoubtedly people reading this thread, lurking, who have had bad experiences with involuntary commitment, or who can identify with such people due to having had bad experiences with unloving family, crappy therapists, or simply through caring for someone who has. It can be a very dark, lonely, hurtful place to be in - and when you read poster after poster, many of whom are professionals in the field, dismiss, ridicule, and deride the very possibility of what these people have actually experienced in their lives, well, that is fucking hellish. I’m not in a position to fix that for them, obviously. What I can do is say that they are not alone. That is not the only way to look at things. Someone out there, however imperfectly, understands the hell they’ve been through and says it’s fucking wrong.
If you can’t find a law that makes it an arrestible crime to set dangerous fires in an apartment building, advocate for a better law.
And yes, the legal system. You can offer psychiatric services to this person but you should not be allowed to insist. You may view psychiatric services as “therapeutic”. The person in question may not.
Orr, if you cannot discriminate a difference between someone being biased, versus experienced, there really can be no possibility of those of us working in the field using our knowledge and experience to combat someone’s misunderstandings.
Consider if we asked you about information related to your past work with the developmentally disabled, then said “but DD clients have been molested by staff” (a factually true statement), followed by “I can imagine…”, “it seems as if it must be that…” “I heard a story about…” and each of their examples, suppositions, anecdotes continued to have more weight than with them any thought-out post of your best information.
Gets pretty maddening after awhile. Imagine for just a moment that you were ignorant about an issue. How would someone on a message board, who knew lots of good info about the topic, they do it for a living, fer chrissake, get through to you?
Good posts, Living in Hell, I’d given up but this thread found new legs. I see you’re not having any better luck than I did, though.
The saving money (the insurance companies not want to pay the bill by not admitting) must be a much bigger deal than any profit motive in the chain to admit.
Truman Burbank
Thank you for your post. That is definitely where my frustration was coming from. I’m debating something with someone who has a set opinion based on limited (second hand) knowledge, limited outdated experience, and limited critical thinking. I’m also debating with someone who admits it is more ethical and compassionate to allow someone with severely impaired judgement to run free and risk him harming himself or others because “hey we can just make better laws.” This is a dead end argument. If anything, it’s reaffirming for me that some people really do need mandated help because they don’t know what they don’t know.
Dangerosa Absolutely. If the insurance company says no, that’s that. It’s a process full of hoops and barriers. The logical conclusion would be that after transcending multiple hoops and barriers, designed to keep people OUT, someone still gets in? Well maybe they need to be there.
Orr, G be a very dark, lonely, hurtful place to be in - and when you read poster after poster, many of whom are professionals in the field, dismiss, ridicule, and deride the very possibility of what these people have actually experienced in their lives, well, that is fucking hellish.
You know? You’re right. I decided to go into this field to keep people sick. To torture them. To hurt them and their families. That’s why I owe $200K in student loans and make the big bucks in such a respected and valued work. I love doing harm as much as possible. I leave every day tenting my fingers and rolling in all my cash and riches thinking about how great it is to destroy humanity at every turn. And when I lost my 6th friend to suicide last month? I laughed hysterically. I said “that is great we never stepped in and tried to help! Good on us! At 39 years old? It’s about time she died!” Now back to my job working with the non-worried well. I have champagne and caviar to consume!
This thread has been fascinating, and occasionally frustrating. There’s been a great deal of projection, and taking things too personally, and much mischaracterization and even some maligning of character.
All it needs now is for 'luci to come in and laugh at all our folly.
AHunter, you keep talking about “disruptive” behavior, which I think is creating a false dichotomy. So there’s “disruptive” behavior, which you seem to be suggesting is, say, wandering around talking to Jesus - annoying but not harmful. Whereas I would think that my coworker probably is in this facility because she either harmed herself or seemed very likely to harm herself. So you’d not allow any forced commitments and be fine with the fact that people would throw themselves off of buildings, not because they were necessarily suicidal day to day, but because they went through an episode that was either not representative or controllable via medication or therapy. But because you don’t think people should be held against their will for anything we just let those people die? Good luck at home keeping your wife away from the knives?
ETA - or should that extend to home as well? After all your wife is trying to cut her throat because of her own thoughts and beliefs. Should you just let her?
You spelled “incompetence, passive aggression, condescending behavior under the ruse of being a crusader, naïveté, and relief” wrong. The last being from me, on behalf of the entire mental health field, that you are no longer working with us. If you practiced at all the way you act here, you did more harm than good. Enjoy your basket weaving or professional forum posting or however you spend your days now.
The problem with your hypothetical is that in the real world people who behave as if they are seriously mentally disturbed are not rational actors and do often wind up harming themselves or others deliberately or inadvertently. It’s not a benign condition. If someone is gibbering or dysfunctional to the point they are not able to govern their own behavior re acting out, yes I want them corralled and evaluated even if they not physically harmed someone yet.
I understand that sometimes mental dysfunction comes in waves and sometimes you are better and sometimes you are not, and when you are better and rational it’s easy to be very resentful of those who locked you down and stigmatized you when you were in the throes of mental dysfunction.
I can be sympathetic to your feelings, but the bottom line is your right to skate the fine line of mentally dysfunctional acting out is entirely subject and subordinate to people’s willingness to tolerate that behavior in civil society. Crazy acting people are often dangerous. People have every right to very wary of people behaving as if they have a mental illness, your insistence that there is some sort of protected entitlement to being batshit insane is not (IMO) a workable position.
I think it’s better than the alternative, overall.
I don’t understand the “wife and knives” reference (maybe you have me confused with someone else?)…
If someone attempts suicide in front of me, I may act to prevent them, there in the moment. But I would not be so arrogant as to lock them up and hold them indefinitely to save them from themselves.
I’m cautiously OK with retaining competency hearings. They’re civil procedures that seem to have tighter standards for the circumstances under which a person may be deemed incompetent and it’s fundamentally a legal procedure, not an ersatz-medical one. I say “cautiously” because if it should turn out that I’ve underestimated the ease with which a person can be ruled legally incompetent, I might have to rethink that.
But by and large insane people are not markedly more violent in general than people who aren’t, and when we are, in fact, dangerously violent, I posit that ordinary laws about illegal behavior would apply to the loonies as they would apply to anyone else.
There are also people lurking who have had friends or relatives either not admitted to, or prematurely released from, psychiatric care who then killed themselves or others.
It’s no more helpful to see posters arguing that such severe mental health problems should just be let be, regardless of the harm it can cause; at least, until it’s too late.
I’ll let you have that, although I suspect the stats somewhat. I’ve been assaulted several times while working in inpt psych, and these were never reported.
So if you knew a new mother with postpartum depression/psychosis, who reported having urges or hearing voices telling her to drown her baby, “but so far I’ve been able to resist”, what should be done?