Involuntary Hospitalization

depression_woman_640Last week I did my very first involuntary hospitalization (or as we call it here in Florida, a Baker ACT) of an adult.

Involuntary hospitalization or commitment is actually a legal procedure where an individual who is showing severe signs of a mental illness such as suicidal thoughts, homicidal thoughts, self-neglect or any other potential to intentionally or unintentionally harm themselves or others is placed into a hospital even if they don’t want to go.

Here in Florida it’s generally a 72 hour hold where the person is evaluated by a nurse and other mental health professionals and then a psychiatrist who will decide if that person is well enough to be released or should stay longer. Technically a 72 hour hold can be extended for as long as a week to much longer in severe cases including state hospitalization which is typically months. It’s a major responsiblity because it’s basically taking away part of someone libery and forcing them into treatment.

In Florida, a doctor, a police officer, a physicians assistant and licensed social workers, marriage and family counselors and mental health counselors all have the authority to put someone involuntarily into the hospital if they feel that person is a threat to themselves or someone else.

I personally don’t take this responsibility lightly, especially working in my new job where I work mostly with adults who’s circumstances generally aren’t as black and white when it comes to meeting criteria to be placed into involuntary hospitalization compared to children. However I know that sometimes it is necessary to keep people safe from themselves, other people and even their illness.

Most of the children and adolescents I had to place into involuntary hospitalization were fairly easy decisions for me. They usually came straight out and told me that they wanted to kill themselves, wanted to kill a parent, or was doing something so outrageous that it was obvious they were imminent dangers to themselves. Most of them, once I told them I was going to have to have them put into the hospital for observation didn’t fight it much. Some cried, but most knew it was for their own good.

Adults however are different. Yes there are plenty of adults who are as obvious as the adolescents, but when it comes to adults, most of them won’t say that they want to kill themselves or someone else, but will skate around it and it becomes not black or white, but grey.

Working in a mental hospital makes it even worst because many of the adults present with some signs of psychosis and it’s not illegal to show sings of psychosis or to be symptomatic, meaning, I can’t hospitalize a schizophrenic just because she’s hearing voices and talking to herself, or a manic woman just because she’s speaking at a thousand miles an hour and bouncing from topic to topic driving her husband and kids up the wall, not as long as both of those people aren’t homicidal or suicidal and are oriented which is the majority of the case.

Often times people will want these people placed into the hospital against their will because they are acting “crazy”, but that doesn’t meet criteria to take away someones liberty and placing them into the hospital.

Because adults have been much more complicated than children when it comes down to deciding if they meet criteria for involuntary hospitalization or not, I was always nervous about writing my first adult involuntary hospitalization order, but when I got this current job, I knew it was only a matter of time. At least 2 to 3 times a week I was asked to evaluate an adult to see if they met criteria for involuntary hospitalization, but most of the time the adults were just symptomatic, maybe in need of some medication, but didn’t meet criteria for involuntary hospitalization.

That was until last week. Last week I was in a training when I got asked me to come evaluate a woman because her therapist thought she may need to be placed into the hospital for her safety.

I met with and evaluated the woman who was obviously in distress. Through my evaluation she told me she hadn’t eaten, slept or bathed in days, nor has she taken her medication because “demons” were telling her not to and were physically holding her down at night.

She then started telling me about being commanded by her deceased mother to do things like book an airplane ticket to another state. She also did not know where she was or what year it was. It was obvious to me that she needed to be hospitalized for her own safety so I had to write an involuntary hospitalization order and she was subsequently placed into our hospital where she would be evaluated, stabilized and released to go back home with a follow up plan of both medication and therapy.

I was nervous as I wrote it, but this one was obvious enough where I felt confident that I wasn’t violating anyones rights and where the power I have to place someone in the hospital against their will was being used for the right reason.

So that was my first adult involuntary hospitalization and I know there will be many more to come because as a licensed mental health counselor I evaluate people’s mental state everyday and working in a large mental health hospital where people come for medication appointments and therapy appointments, but sometimes end up presenting in ways that suggests they need to be placed in the hospital for stabilization, writing involuntary hospitalization orders is part of my job and it’s a responsibility I don’t take likely.

Psychiatric Hospital: A Quick Glimpse Inside the Madness of an Institution

I normally try not to post on Friday through Sunday, so today will be a light post and a short break from our discussion on the Pervasive Developmental Disorders and will continue on Monday with Rett’s Disorder. Today however I’d like to share some of my past work experiences.

For three years I worked overnight in a mental hospital. It was three years I’ll never forget. After spending years in undergrad and grad school learning about all the diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM), it was great to actually get a chance to experience some of those disorders first hand.

Working overnight in a mental health hospital definitely gave me a lot of insight into mental illness and people who are often oppressed by the system that is set up to help them. It is also where I honed my assessment and diagnostic skills as a clinician, being able to work along side other seasoned clinicians, psychiatric nurses and psychiatrists.

The mental health hospital can be a life saver for some (if you have the right insurance/money) or just a revolving door of endless misery and disheartening for those less fortunate, which are usually the ones who need the services the most. With the right resources you get all the help (counseling, medication, case management, etc.) you need, otherwise you just get stabilized and sent back out the door (usually to return again and again without the proper treatment).

Still, for what it is worth, there is nothing like working in a mental health hospital, especially overnight when the clients are usually the most eccentric and usually outnumber the staff 3 to 1. You can go from consoling a woman suffering from post-partum depression one moment, to restraining a highly psychotic person the next, over and over again.

One night in particular I saw a young doctoral candidate who was contemplating suicide due to depression, social anxiety and paranoid thoughts that his peers thought he wasn’t good enough for them. Then I saw a woman who caught her husband in bed with her brother, went out drinking and then decided to try to slash her own throat.

All I could do at 3am in the confines of the mental health hospital was offer those troubled individuals some hope and guidance so that maybe they’d see light at the end of what they perceived to be a dark, endless tunnel of anxiety, depression and despair. So for them, and the other clients, at least for that night, the mental health hospital was a safe place for them to let down their guards, share their fears and lose their minds without judgment or recrimination.