Also would be very interested to hear from those who were involuntarily treated themselves
I’m a psych nurse now and have been personally hospitalized 4 times and have had over 300 hours of outpatient therapy, but I’m not actually sure what your specific questions are. Here’s some example ones but you’re free to ask more if you like. (also this is my night of and I’m a bit schwasted so this is gonna be slightly stream-of-consciousness).
Are you asking for the nuts and bolts of how to get it done with the highest likelihood of actually getting your loved one help without getting them shot by the cops? No idea. This is highly dependent on what resources are available in your specific area, what criteria they use to triage the needs of the people they serve, and the local legal system, both as it’s engrained in law and how that law is typically interpreted/used. The best way to find out more about this is to join a support group for family/loved ones of people with mental illnesses in your area. Even if you go to a zoom or other virtual support group, try really hard to find something very local. People who have been doing this in your area for years are going to know waaaaay more about the nuts and bolts of this situation than some internet rando who doesn’t know shit about the specific place you live in. Therapy for you is also a great option if that’s accessible to you.
Will being hospitalized traumatize your loved one: almost definitely. Even when it’s completely necessary it sucks, and honestly the more it’s needed the more it sucks. At best, it’s soul-crushingly boring. The worst depends on where you live and which things that area considers “human rights,” as well as the overall quality of the specific facility and the overall acuity/severity of the mental health crisis in your area. I was happy to work for a place that I considered decent quality for a while, but things have been degrading for a bit now and I’m on the hunt for greener pastures. I also work probably one step below what would be considered a “psychiatric ICU” in that I have some very sick patients who often require some very intensive and invasive care. A couple nights ago my coworkers had to forcibly get shit and piss covered clothes off a patient because a) the acidity was starting to burn/dissolve their skin and b) they wouldn’t willingly stay in their room and we can’t legally lock them in, but it’s also not fair to the other patients for them to spread their shit and piss all over the communal areas. And that’s not even unusual. We’ll probably have to do it with an entirely different patient within the next month. I really hope your loved one does not require that level of care, but if they do, there’s very little I can do to keep it from traumatizing them, and I have a bunch of education and experience specific to this area.
Will this damage my relationship with my loved one? again, almost definitely. You will need to decide if you think the possible benefit is worth being the bad guy in your loved one’s story. I’m the bad guy in a lot of people’s stories; some people just need them for what they’ve been through to make sense. I do my best to form that helping relationship, or get it back when I lose it, but sometimes it’s just not possible and if I’m given a choice between being liked versus every employee and patient on the unit getting through the night safely, I’m taking option 2. The difference is I usually don’t have to see the person again or even interact with anyone they know or who knows them. The patient gets to remember me as that awful bitch who drugged them and stole their shit covered clothes (even if we did give them back after washing and a spare set to wear in the meantime) and never have to even look at me again. If they do see me again, it’ll probably be purely within the context of them being acutely ill and they’ll still be able to leave me behind again and go make the best of their life outside the hospital. Having a loved one be the bad guy, or to be the bad guy to your own loved one, is an entirely different animal.
But is there any way I can talk them into this willingly? maaaaaaaybe. And if there is, the only person who would know is probably you, or someone who’s even closer to them if that person exists. I don’t know your loved one from Adam, so I don’t know what motivates them or what’s important to them. If I talked to them personally and at length I could probably make some educated guesses, but if there’s something important enough to them to confront this issue the way they would actually need to to recover fully, you’re the one who probably knows what it is. Those support group people or a therapist may be able to help you phrase it better.
I thoroughly appreciate everyone’s responses. In hindsight, I probably could have put the question in clearer context to avoid sounding like I was just trying to cherry-pick justifications for involuntarily committing someone without the legitimate grounds to do so (and it’s become ever more clear that this is a deeper philosophical question about how much control we should have over a person’s autonomy when they display signs of extreme mental distress). Ultimately, I share the same concerns that many of you have about how this could be misused to hold someone against their will when a third party deems their life isn’t “normal”. There are of course people in our society that would like to use such allowances to involuntarily treat people who are NOT suffering from a mental illness but fit some categorization they deem as “abnormal” -or- treat people who are suffering from a mental illness but are content with their lives (sorry, I’m sure there’s a clearer way to phrase this but I’m struggling how to elucidate it; hopefully this is clear enough).
I was mainly curious to hear of other peoples experiences, what the outcomes have been, how things could be improved, i.e. get a better understanding of how it works, NOT try and use it as a justification. And I hope anyone that reads through this thread takes extreme care and consideration with this stuff, since it is such an extreme course of action to take.
I’m admittedly a bit worried that this post might make people feel targeted themselves or feel unsafe in someway, which was definitely not my intention.
Oh. If you are looking for an ethical line, it sounds kinda simplistic but it’s generally “are they at risk of harming themselves or others” and not “are they living in our consensual reality”.
And it does kind of suck, because that’s why our roommate got returned to us (she did later end up in the residential system, which was also a nightmare for her, but she just never regained the ability to navigate the world, and that is not uncommon with schizophrenia, it can sort of explode as people become adults) and because people who are suffering and out of touch resist treatment that could help.
When I was a teenager (1980s) parents routinely got oppositional kids hospitalized, it was a mess, there was a whole for profit industry for institutionalizing kids who weren’t really even mentally ill, Charter was the name I remember. You aren’t wrong it’s a slippery slope.
It depends on the state/county. I’d probably preface this with… Depending on where you live, your local behavioral health systems may be… negligible. As luck would have it, I was familiar with my hometown’s resources. I find when people are in crisis, it’s beneficial for them to voluntarily seek help. Make it super easy for them. Know where intake is. Know which places have a better reputation. It’s usually not the ER. That can take eons. The one time I did try to help someone involuntarily, it didn’t go well. We were not friends after that. You go to the department of human health services (dhhs), talk to somebody there regarding the person, then you file a form.
Tl;dr: google “[your county] dhhs behavioral health” and if your area has its shit together you’ll find it
Appreciate you sharing your experience. Unfortunately, the person in my life is so staunchly opposed to getting any kind of care, partially out of stubbornness but mainly because of semi-delusional thoughts (I say “semi-delusional” because it’s no delusion that mental health care in our state is incredibly lacking – but also there’s actual delusional “I’m being targeted” type stuff too). It sucks bc it just feels like we have to wait around for something really bad to happen before they can get the care they very clearly need.
Have you ruled out the possibility of them actually being targeted? Aside from this belief, what is wrong in their life that it warrants violating their right to self determination? Are they hurting people?
That’s entirely possible and, yes, I ultimately fully want to respect their autonomy and do not want to commit them against their will. In the past though, they have talked about plans of ending their life and have seriously harmed themself in an attempt. And I can’t really say that there’s anything ‘wrong’ with their life but they do seem very, very miserable. While don’t wish to make a judgement of the quality of their life or insist on how they should be living, I do want them to feel less torment. Its sometimes hard to be sure of the extent of their anguish, because they’re so unwilling to talk about it.
Have you tried writing to them? This helped my partner and I. Tell them how you feel, your worries, what you want and why. Give them as much time as they need to process it and respond.
How recent was the suicide attempt?
Never been committed or had to go through the process myself, but I do have some second-hand knowledge from my work as a 911 dispatcher.
Most important to keep in mind is that the specific laws and processes are going to vary depending on what state or country you live in, who can initiate it, what’s involved in the process, how long they can be held, what the process is is to extend that hold if needed, etc. will all vary a bit.
Most commonly, the requirements include something like the person must be a danger danger to themselves or others, and the relevant law will likely spell out how that is determined.
In general, an involuntary commitment should be a last resort. Probably not surprisingly someone who doesn’t want to be there probably won’t try very hard to keep up with their treatment, and since they can usually only be held for a few days without taking extra steps to extend it, they may be able to keep themselves out of trouble for just long enough to get released and then go right back to whatever they were doing to get committed in the first place. If you can somehow convince them to go of their own free will, they’re probably going to be a lot more cooperative, and sometimes, depending on the exact circumstances, it can actually be harder for them to leave before they’re better when they go voluntarily than when it’s involuntary.
Thanks for that. That clears up a lot of what I wasn’t sure about. I’m curious, from your experience in that job, did you ever feel like certain steps in that process could’ve been different to better help people? Genuinely curious
Again, things are going to vary from one place or a person to another and I’m afraid there probably isn’t a simple, satisfying, one-size-fits-all answer to that question. There’s a lot of room for improvement at basically every level with mental healthcare, though it’s pretty hard to pick one or even a couple things and say “do this one thing differently and things will be better” because each of those one little things tends to lead straight down a rabbit hole of 10,000 other things that would also need to change for it to work.
Some very broad categories of things I’d like to see improved
More funding, resources, training, etc. there’s only so many psych hospitals, so many beds, doctors, nurses, etc. so even if we could somehow funnel everyone who really needs treatment down a path towards getting it, there’s really no way for them all to get it. We need to make sure that everyone who needs it is able to access high quality mental healthcare.
A whole lot of education, public awareness, societal changes, etc. need to happen. There’s still a whole lot of stigma and taboos about mental health issues and treatment. People don’t know what’s involved, are afraid of getting branded as crazy, don’t know what resources are available to them, how to access them, what their strengths and limitations are, they can’t afford it, a long stay in a psych hospital may mean losing their jobs or their home. Damn near every night I get a call for a domestic where I hear one of the parties yelling at the other that they’re going to get them committed, and often there’s no real sign that anyone involved actually has any kind of mental health issue, they’re mostly just idiots or assholes, so it’s usually an empty threat and paints the picture of treatment being some sort of punishment or a weapon to use against someone, and that sort of thinking really damages the reputation and efficacy of mental healthcare.
There probably need to be new categories of healthcare created, or if they do already actually exist, they need to be expanded. I can’t tell you how many calls I get a night from people who clearly have some kind of psych issues, but wouldn’t meet the bar of being a danger by any reasonable definition. I could probably rattle off a dozen names and addresses off the top of my head of people that I speak to almost every shift who probably really need to be in a psych hospital for a while to get themselves straightened out, but since they’re in no way dangerous, our hands are kind of tied, and the best we can do is offer them a mental health crisis line they can speak to, or send a cop out to check on them, make sure they’re ok, maybe talk to them for a while or leave them some pamphlets or business cards or something for resources they can try and hope they take the next step themselves, or at the very least tell them to stop calling 911 (which doesn’t really have any teeth, no one really wants to go through the paperwork and court hearings and such to get them in trouble for abusing the 911 system, I’ve only heard of it actually happening once in these kinds of cases in the 5 years I’ve been working here, and in their minds they’re calling about an actual emergency, and we don’t want to discourage them from calling if/when there actually is something going on, it’s happened before that they’ve actually called in a real incident) so there needs to be some sort of middle ground between hauling them off kicking and screaming to be committed and just making suggestions and hoping they follow through with them, and I don’t really know what that middle ground is.
What does your username mean?
From the Library of Babel by Jorge Luis Borges
I don’t understand. Is that a book and “dhcmrlchtdj[underscore][underscore]” represents something from the book?
The reason I ask is it sounds like a random bunch of letters to me. Makes me think troll account. Makes me think super serious topic being discussed on a playful whim to map us out culturally.
Sorry if I’m seeing this wrong. It’s just such a heavy topic I’d rather know I’m interacting with a real person.
Committing a person is an extremely serious action which does violate their rights. Much like conscripting soldiers into a war, or killing an innocent person to save five innocent people, it’s a human rights violation that shouldn’t be discussed lightly and should only be considered when there is literally no other option.
So far it sounds like your target “thinks he’s being targeted”. Which he is, by us in this very thread. So aside from having a healthy intuition about when he’s in danger, what’s the mental health situation that warrants violating this person’s rights for his own safety or others’?
Sorry if this comes across as overly hostile. That’s not my intention. I’ve just seen too many people’s lives ruined by being involuntarily committed. And I don’t like discussing such drastic moral hazards with a username that looks like random letters followed by some underscores.
You’re being really critical here for no good reason, it almost feels like you’re the one with a troll account.
You could clear up your confusion about the username by a quick Google search. The library of babel is a story Jorge Louis Borges, about a vast library that contains every possible combination of letters and words, and if you Google “dhcmrlchtdj,” you can see that it’s one combination of letters that he specifically calls out to illustrate that point.
And like you said, an involuntary commitment is a serious issue to contemplate and a sensitive topic for a lot of people, I think it’s pretty understandable that someone may not want to share a lot of details about what their friend is going through.
I literally have the same question.
Why
Because my mother is an alcoholic dependent b*tch who ruins everyone’s lives and has no friends.
The laws vary so much by state that any advice given here is not likely to be useful as far as specifics. Here in Texas, either a police officer can evaluate that someone is at risk of harming themselves or others and issue an emergency detention, compelling a psychiatric evaluation, or an outpatient doctor can write a certificate of medical examination and a family/outpatient team can file an order of protective custody directly with the county court, which a judge has to accept and sign. The specific criteria you can use for either of these varies by state, as does the process.
Elsewhere I read you’re concerned about your loved one’s delusional thinking, which unfortunately is not likely to meet the threshold for involuntary treatment without significant behavioral issues. The best thing for you to do right now is to take care of yourself, recognizing you and your boundaries are the only thing you have control over. Maybe check if you have a local NAMI chapter and see if they have a family support group. I guarantee you there are people there who have been through similar experiences.
Depends on where you live, the process is going to be different everywhere. Even in the USA, it’s different state by state. I’ve been involved in the process in PA, but can’t speak to any other state
Twice. Once my roommate had a schizophrenic break, we called the police as we didn’t know what to do, they did the involuntary commitment to the emergency mental health care and they had us come get her in 3 days, because they didn’t have funding to help everyone and she at least had a place to go.
One of my (adult) step kids also suffers mental illness, she trusts me so when she was having a psychotic break I was able to get her into the car and out at the emergency room, unfortunately this was during COVID and they would not let anyone walk in with her but once she was through the doors they handled it and sent us a letter with the legal information.
Basically, if you can get them to go to the emergency room and self-commit they will have an easier time. If you cannot, here the police are the only alternative, you may have more specialized resources where you are. Hopefully. But it’s an emergency, the emergency room is a good place to start.
I hope you don’t call police anymore because you’re likely to get them killed now a days. Instead just call social services or something but not the police.
There isn’t anything here yet (you can’t call 911 and get someone other than the cops, there is a helpline for people to call themselves though, a suicide prevention line that does try to put people in touch with help) and I strongly agree with you it’s not police work. Luckily she was a young white lady, sort of cop kryptonite.
Hopefully it’s better in other places but it’s a difficult problem, no way to make it an easy one.
I’m not sure how useful this will be because I’m in the UK but my mum was admitted to hospital 7 weeks ago with an infection related to her recent chemo/immunotherapy for breast cancer. She only 60, her oncologist was sure he could functionally “cure” her cancer and she was cognitively and emotionally sound, thus she didn’t make an advance directive (a form that expresses what medical interventions you do/don’t want in the future) or give my dad power of attorney. There was no need - she was just suffering the usual side effects of chemo, otherwise she was a normal fully functioning person.
Unfortunately she suffered a swift cognitive decline in hospital and began to refuse basic treatment (like antibiotics for the infection). She began to try leaving the hospital on her own. Once she became too weak to get out of bed she would refuse to be cleaned and changed, refused to eat, refused any tests, even X-rays. It was a really difficult situation because as the doctor put it, people are allowed to make “bad choices” when it comes to life saving health care (think Steve Jobs) but only if they are competent enough to fully understand the consequences of their decisions. My mum was deemed incompetent and because she didn’t make a power of attorney previously, we as her family didn’t have any legal standing.
In the UK we have the court of protection- the hospital can petition the court and ask for a separate court appointed third party to make the best medical decisions in mum’s interest. They like to use it as sparingly as possible and it’s stopped as soon as the patient is competent again. Before they petition the court though they try everything possible to get the patient to agree to treatment - cajoling, coaxing, bargaining etc. They take the slightest hint of agreement as permission to do whatever it is they need to do. Mum doesn’t really understand what’s going on anymore - or even where she is - but she trusts my dad and I and we’ve built a strong relationship with the doctors at the hospital. So far we haven’t needed to go to court. They give her morphine every two hours and lorazepam twice a day to reduce the pain of the changes etc and make her more compliant. Yesterday we started mirtazapine (an antidepressant) mainly to stimulate her appetite as she pulled out her NG tube again. We know that she wouldn’t want to take this drug if she was competent, but we also know she wouldn’t want to prolong her hospital stay by not eating if she was in her right mind.
It’s a horrible game of trying not to go against my mums wishes wherever we can, working out of she understands her decision, trying to “trick” her into taking essential drugs/complying with essential care etc. and then trying to explain and justify ourselves during her brief moments of semi-lucidity when she accuses us of wanting her to be ill/be stuck in hospital/to die. It’s absolutely awful for us and mum but I do think the overall guidelines set by the NHS/court of protection are a good way to manage a very difficult situation.
I’m sorry you went through all of that, it sounds terrible.
For anyone reading from the US, the system is a little different there. Treatment decisions would default to a health care proxy if a person is not competent (and like this poster said, that means unable to understand, ask questions, and articulate choices, not making bad choices). A health care proxy is different from power of attorney (in the US), check your state for forms to pick one. It’s always a good idea to have one declared and paperwork with your doctor, however if you don’t have one selected on paper, then default health care proxy is closest relative (spouse, then adult kids, then parents, then siblings, usually). If no health care proxy can be found, only then would the court system get involved and appoint a guardian.
In regards to the original posters question, involuntary commitment for a mental health issue may involve a competency determination, but is much more involved and needs to involve courts very quickly. In general only a 72 hour hold can be placed by a doctor without a court getting involved. It’s less common too, most people in inpatient mental health situations are in voluntary stays.
In addition to the ED which is always available if needed as a last resort, check your local area for mental health crisis lines and support. These are often a local group such as through a county and may be affiliated with mental health providers, can often even make home visits and quickly connect people with resources and advice on how to go forward.
We kinda assumed my dad would be her proxy as he’s her next of kin (they’ve been married 42 years) but we don’t have the system here. My dad in particular was upset that a third party stranger would make the medical decisions for mum if it came to it, not him. The only thing they did let us decide was whether they’d employ “heroic measures” on the two occasions when she very nearly died. They accepted our request that she not go to intensive care or be resuscitated - that’s something we had spoken about before and we were certain it was mum’s wish.
I’ve made my dad promise to write his advanced directive when this is over. Speaking as a daughter going through this nightmare right now, I would implore anyone over 50 or with serious health issues to write your advanced directive now or whatever the equivalent is in your country - or just have a conversation with your nearest and dearest about what medical interventions you want to have if you’re too ill to speak for yourself, if nothing else. This would have been an awful awful experience either way, but if she’d written an advanced directive or arranged power of attorney before this happened, at least we wouldn’t have this agonising “are we doing the right thing” question hanging over us too.
ETA: the Terri Schiavo case from the US is an example of why I think the court of protection/independent third party system is better than the automatic next of kin/proxy system you guys have. Although it’s been awful and initially insulting to experience, I completely understand why “take my word for it” isn’t considered adequate for medical decision making here. Before things deteriorated so suddenly, mum was saying wildly different things to my brother, then me and then my dad. Save your family this heartache - write your intentions out now while you’re well enough to do so.
Sorry you have to experience this.
Thank you. It all happened so quickly and things got worse than I ever could have imagined, it doesn’t feel real. (Google Steven Johnson’s Syndrome/TENs if you like nightmare fuel.)
Medically she’s ready to be discharged to an inpatient physio centre now, but she just won’t eat or drink. I’ve just come back from my daily visit and she told me I was rude and condescending and that she used to love me but doesn’t anymore. She doesn’t have dementia or Alzheimer’s - this is just the effect of a fever on a very frail and weak older person who had very intensive chemo and immunotherapy.
I was only asking her to drink one sip of the high calorie drink. They’ll put her back on the nasal feeding tube if she doesn’t start eating again and then she will need to stay in the hospital. It’s so frustrating, incredibly upsetting and beyond exhausting. I was so tired today I just burst into tears when she started being nasty. Normally I can hide it, but it was too much today.
Without going into too much detail (because it isn’t really my story to tell) a close friend of mine recently went through something that was very similar. The woman has passed now but the impact on the individual family members and the relationships within the family continue to play out. Almost none of it is positive.
There were some very hard decisions to be made and disagreements about how delicate the situation was or wasn’t. People drifted in and out of the picture in the final months and several aren’t on speaking terms now that she’s passed.
Before the mental decline everyone’s assumption was that there would be fighting about money and inheritance. As it turned out the argument was about human decency more than anything.
Again, I’m sorry you have to experience it. I don’t have anything more to offer than encouragement to do right by yourself and your loved ones wishes. Make sure you can live with a clear conscience.
Thank you, I appreciate it. I’m sorry for dumping that on you, it was a bit cathartic after a horrible day!
Luckily (?) we’re pretty close to the bread line so there’s nothing to argue about RE her will. We had a weirdly similar situation with an extended family member inserting themselves into the discussions around my mums care with a completely different opinion than everyone else and they caused nothing but more upset and angst. I guess situations like this really can bring out the best and worst in people.
Thank you for the advice about listening to my conscience. When everything is so uncertain and confusing I guess it’s the only thing I can rely on. And I know in my heart that I’m doing everything that I can to help my mum and that if she were well she’d be grateful not hurtful.
Thank you again for the kind wishes and advice 💕
