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New Mental Health Parity Law February 9, 2010

Posted by Crazy Mermaid in Healthcare, mental illness.
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Sunday’s Wall Street Journal article by Jillian Mincer, Mental-Health Benefits, heralded the new Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, which took effect January 1, 2010.

The forerunner of this new act, The Mental Health Parity Act of 1996 (MHPA) said that a group health plan couldn’t impose annual or lifetime dollar limits on mental health benefits that are less favorable than any such limits imposed on medical surgical benefits. This act was necessary because it was common practice  for insurance companies to  pay more for medical illnesses than mental illnesses.

For example, if Harry required open-heart surgery, an insurance company limited the amount of money it would pay a provider to $2 million over the course of Harry’s  lifetime for his heart. That same insurance company would turn around and limit the amount of money it would pay a provider for Tom’s depression to $750,000 over the course of his lifetime. The MHPA of 1996 mandated that if the insurance company allowed Harry $2 million in insurance for his heart, then Tom got $2 million for his mental health treatment. But that law didn’t go far enough. The insurance industry still managed to heap tons of discrimination on the treatment of mentally ill patients.  So we went to work, cutting away some of the insurance industry’s wiggle room.  The result was the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008.

The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 went into effect in October 2009. But the new coverage wasn’t available until only a little over a month ago (January 1, 2010), which is when new insurance policies went into effect.

The MHPAEA still allows companies to decide whether  to offer mental health and substance abuse disorder (MH/SUD) benefits in their benefits package. They don’t automatically have to offer them when they offer medical health policies. So that means that the only groups that are affected by the new law are those that  already have mental health and substance use disorder (MH/SUD) benefits in their benefit packages and choose to retain those benefits.

Key changes made by MHPAEA, which is generally effective for plan years beginning after October 3, 2009, include the following:

• If a group health plan includes medical/surgical benefits and mental health benefits, the financial requirements (e.g., deductibles and co-payments) and treatment limitations (e.g., number of visits or days of coverage) that apply to mental health benefits must be no more restrictive than the predominant financial requirements or treatment limitations that apply to substantially all medical/surgical benefits;

• If a group health plan includes medical/surgical benefits and substance use disorder benefits, the financial requirements and treatment limitations that apply to substance use disorder benefits must be no more restrictive than the predominant financial requirements or treatment limitations that apply to substantially all medical/surgical benefits;

• MH/SUD benefits may not be subject to any separate cost sharing requirements or treatment limitations that only apply to such benefits;

• If a group health plan includes medical/surgical benefits and mental health benefits, and the plan provides for out of network medical/surgical benefits, it must provide for out of network mental health benefits;

• If a group health plan includes medical/surgical benefits and substance use disorder benefits, and the plan provides for out of network medical/surgical benefits, it must provide for out of network substance use disorder benefits;

• Standards for medical necessity determinations and reasons for any denial of benefits relating to MH/SUD, must be disclosed upon request;

• The MHPA parity requirements under existing law (regarding annual and lifetime dollar limits) continue and are extended to substance use disorder benefits.

While these new requirements are getting us all closer to a more just mental health system, we still have a long way to go.

Note: Check out Time Inc.’s interview with Senator Pete Domenici after passage of the law, whose daughter suffers from schizophrenia. A fascinating read. http://www.time.com/time/nation/article/0,8599,1848887,00.html.

Shortness of Mental Hospital Beds February 3, 2010

Posted by Crazy Mermaid in Mental Hospital, mental illness.
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Society seems to think that if we eliminate the places people can go for help managing their mental illness, then we can eliminate the illnesses themselves.  We can say to ourselves “Look! The places we used to treat mental illnesses at are all gone!  That must be because there are no more mental illnesses requiring hospitalization! Yay!”

In 1973, Washington State shut down Northern State Hospital in Sedro Wooley, which is about an hour’s drive from Seattle, due to budget cuts.  Back in its heyday, Northern housed 2,700 patients.  Despite the substantial increase in population from 1973 to the present (almost 40 years), there has been no increase in the number of mental hospital beds. In fact, they keep decreasing.

Shutting down the facilities is society’s way of trying to make the problem go away.  If there’s nowhere to treat the problem then the problem must be gone.

It’s interesting to look at the presidential familial histories of the presidents in office when certain actions were taken regarding mental illness. For example, when John F Kennedy, whose sister was lobotomized, was in office in the early 1960’s, the secrecy of mental illness was blown wide open. Mental hospitals were built, programs for mentally ill were implemented, cruel practices like lobotomies were stopped, and mental illness finally came out of the deep recesses of the closet.

Then, when Ronald Reagan, a man with no public ties to mental health, took office in the 1980’s, politicians were looking to shrink government and reduce spending. With the advent of new medications, the people governing the nation got the (wrong) impression that mental hospitals were suddenly passé, no longer needed because new medication took the place of hospitalization. The general idea behind the shuttering was that the new drugs made hospitalization obsolete, and that those housed in the facilities were fairly long-term residents who would be better served outside the state-run hospitals rather than inside them.

The sad truth is vastly different. The true effect of this bed shrinkage is felt most clearly on two groups of people: those needing long-term care and those looking for short-term care . People seeking short-term care need specialized supervision and care in order to get their medications started or under control under strict medical supervision. They and their families suffer from the shortage of hospital beds.  They go untreated, unable to get to a place where they can manage their illness.

Those needing short-term care but not finding it soon turn into those needing long-term care. Unable to find long-term care either, they take to the streets. We know them as the homeless population.

The medical community acknowledges that there is a need for more beds, but the reality is that there is no movement afoot to do anything about it. Especially in this cash-strapped time, there is no room in our budgets for building new mental hospitals, despite our increased population. That’s sad.

Three Party Commitment Petitions January 29, 2010

Posted by Crazy Mermaid in Involuntary Committment, mental illness.
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Throughout my (admittedly very short) “career” as a spokesperson for NAMI’s In Our Own Voice program, I hear the same sad story over and over again.  Parents, afraid of their adult dysfunctional and/or dangerously mentally ill children, are unable to get help for them. With nowhere to go but the streets, parents reluctantly allow their scary offspring to stick around home, hoping that the now-grown “child” will somehow miraculously become well enough to get the medical help he needs. As the child slips deeper into the clutches of mental illness, his paranoia grows stronger, and the parent joins the long and growing list of “they” who are out to get him.

What is  a parent supposed to do? Throw the child out on the street? And yet the child cannot fend for himself because of his severe mental illness. Unable to get the child help because of the way the commitment laws are written, the parent suffers through years of living this tortured existence. Coming home from work each day, wondering if today will be the day.  Waiting for the child to make a real solid attempt at killing himself or someone else  so that he can finally cross that threshold to get involuntarily committed to a mental hospital.

Today’s Seattle Times featured an article written by Martha Monfried about the disgusting state of affairs regarding mental illness in Washington State. In her article, she cajoled the legislature to pass legislation this session that would allow families in Washington State to petition the court to commit their loved ones who suffer from mental illness.  Not knowing whether she was asking for new legislation or  passage of existing legislation, I did some searching and found nothing along the lines of anything resembling existing legislation for the State of Washington. That doesn’t  mean it isn’t out there. It just means I can’t find it.

In the meantime, I did find other legislation.  I like what I found. What do you think?

Three Party Commitment Petition

Wisconsin is a state of least restrictive treatment, meaning a person seeking treatment for mental health, developmental disabilities, drug dependency or alcoholism has the right to pursue treatment in the least restrictive environment appropriate for their needs.

If a person is willing to seek help on a voluntary basis, there is no need to pursue a Three-Party Petition.

Since Wisconsin is a least restrictive state, the law governing our mental health system (Chapter 51) emphasizes protecting individual rights and liberties.  The laws favor voluntary over involuntary treatment.  However, there are three ways in which to force involuntary treatment in the State of Wisconsin:

  • Emergency Detention
  • Director’s Petition (also known as Director’s Hold)
  • Three-Party Petition

Emergency Detentions – (51.15, WI STATS)

These are initiated when an individual is presently a danger to themselves or others.  The detention is obtained by contacting law enforcement.

Director’s Petitions (or “Director’s Hold”) – (51.10(5)(c) and 51.15 (10), WI STATS)

These are used only by psychiatrists when a person who has been seeking services voluntarily and then decides that they want to leave the psychiatric unit and the psychiatrist does not believe that is appropriate for the person.  The psychiatrist must be able to state that the person will be dangerous (to self and/or others) if allowed to leave the hospital.

Three-Party Petitions – (51.20 (1), WI STATS)

These actions occur if there are recent dangerous conducts/behaviors present AND one or more of the following disabilities exists:  mental illness, drug dependency and/or developmental disabilities.

To substantiate mental illness, drug dependency or developmental disability, you will need to provide information on the current physician, diagnoses, medications and dates of last treatment.  The person also must be a proper subject for treatment.

Dangerous conduct/behavior is defined as specific acts, attempts or threats which constitute a substantial risk of physical harm to self and/or others, according to the following standards:

  1. Danger to oneself (for ex., suicidal thoughts/actions)
  2. Danger to others (for ex., homicidal thoughts/actions)
  3. Impaired judgment in that the person is not able to make decisions that are appropriate and potentially dangerous (for ex., believing that they possess super powers and that they can fly if they jump off a building)
  4. Behavior indicating the person can’t take care of themselves or meet their own basic needs(for ex., person refuses to eat or does not dress appropriately for the weather conditions) so that substantial probability exists that death, serious physical injury, debilitation or disease will imminently ensue unless the person receives prompt adequate treatment.
  5. Fifth Standard – This standard is different from the other involuntary civil commitment statutes because it requires a finding that the person suffering from a mental illness is in need of treatment AND there must be a finding that the person is incompetent to refuse medication.  This is why the Fifth Standard is also referred to as the “need for treatment” alternative to the other four standards.  The Fifth Standard also does not require the finding of dangerousness to be immediate or overt, as it is with the first four standards.

Three-Party Petitions for Alcoholism also have a different standard.  A petition may be filed if the person’s dependence on alcohol substantially impairs or endangers the person’s health AND their social or economic functioning is substantially disrupted.  Please remember that simply being an alcoholic is not automatic grounds for a petition.  There are many people who are alcoholics and still able to function well enough in their lives.  In this context, substantially means a severe degree of impairment, endangerment or disruption.

This process may take time.  Depending upon several factors and the evidence presented, some petitions could take weeks to bring to court.  During this period of time, an emergency detention can be started, if necessary.  If the emergency detention process is started, the three-party petition will be put “on hold.”

If you believe that you have the necessary information to meet the standards for a three-party petition (as outlined above), you may contact the Information & Assistance unit of the Racine County Human Services Department at 262-638-6321 to start the referral process.  Please understand that, in addition to meeting the standards, the following criteria must all be met:

  • There are three (3) people, including yourself, with at least one person with first-hand knowledge of the person’s situation
  • All three persons are willing to sign a petition
  • All three persons are willing to testify in court

Website: http://www.hsd.racineco.com/MentalHealth/ThreePartyCommitmentPetition/tabid/194/Default.aspx

Psychiatrists January 27, 2010

Posted by Crazy Mermaid in Psychiatrists, Recovery, mental illness.
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There’s nothing more important to a person with a mental illness than their relationship with their psychiatrist.

Some people, not realizing the critical difference between a psychiatrist and other medical disciplines, make the mistake of substituting their General Practictioner (GP) or other “mainstream” doctor or nurse for the services of a psychiatrist. That’s like going to a podiatrist (foot doctor) to get a mammogram (breast exam).

The primary difference between a psychiatrist and another type of doctor is that the psychiatrist has been trained in diagnostic evaluation of mental disorders. This is an under-appreciated fact in the medical community as well as in the general public.

For example, if a patient comes into a GP’s office and announces that he has a broken ankle, the GP won’t begin treating the broken ankle without taking xrays and verifying the patient’s self-diagnosis. Generally, the GP will have the skills necessary to perform those tasks.

But that same GP won’t hesitate to begin treating a patient coming into his office complaining of depression. Without verifying that the patient has depression rather than bipolar disorder or a number of other psychiatric disorders, the GP begins treatment of the patient. He has neither the knowledge nor the skill necessary to do the diagnosis, and yet he has no qualms about treatment. This type of thing happens more frequently than not.

The right psychiatrist assesses the patient, diagnoses the patient, and then helps the patient manage his symptoms (not cure the illness) the quickest and least painful way possible, while a GP messing around with psychotropics (mental illness drugs) is likely going to do the patient more harm than good.

GP’s, being very conservative in trying to treat something they really don’t understand, have a tendency to prescribe only one drug at a time to a patient with symptoms of a mental illness rather than the cocktail of drugs needed to combat all of the person’s symptoms.  They don’t know how the mental illness drugs interface with each other, and  they’re afraid of doing the wrong thing.  So their one prescription drug usually does little or nothing to help the mental patient.  In fact, sometimes the patient gets the (wrong) impression that a particular drug isn’t working for them at all when the real problem is that the supporting drugs are missing from the cocktail.

A good psychiatrist gives the patient confidence that there is no problem that is insurmountable. He has “been there, done that” so there are few surprises. And when there is a surprise, he knows how to trace the cause so he can find a solution. The average person has no idea how much of a comfort this is.

A good psychiatrist gives a specific timetable of how long a drug will take to kick in. In my own case, upon my discharge from a mental hospital, my (new) psychiatrist told me straight up to expect several months worth of bad side effects as the drugs built up in my system. He said “give me two months” to get the side effects under control. Not gone, but under control. So I had an end in sight. I could put up with the terrible side effects for two months, whereas I couldn’t do it for an indeterminate span of time. In fact, some of the side effects were so bad that had I not known how long they would last, I would have discontinued my meds (as many people with mental illness do) rather than face a potential lifetime of those side effects.  A good psychiatrist will help keep the patient on his medication so that the medication can do its job.

Having to manage with a broken leg for a lifetime is completely different than having to manage a lifetime living with the symptoms of a mental illness. How long can you stand having voices constantly talk to you before you want to jump off a bridge just to get away from them?  How long can you stand to see terrible pictures when you close your eyes before you want to die to get away from them? The psychiatrist’s  reassurance that all problems are fixable puts the patient’s mind at ease. Whatever the problem, I have confidence that my psychiatrist, Dr. K, can fix it.

Mental Illness and NAMI Family to Family Facilitation Training January 21, 2010

Posted by Crazy Mermaid in NAMI, Recovery, mental illness.
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This past weekend, I had the opportunity to participate in some training. Orchestrated through NAMI (National Alliance on Mental Illness), the training, called Family to Family Support Group facilitation training,  was designed to teach us how to facilitate a group of family members coming to a peer support group.

When I signed up for the training weeks ago, I was given the distinct impression that both mentally ill and non-mentally ill people would be participating in the training. It made sense at the time that both groups could effectively facilitate such a support group, although the perspective of each facilitator would necessarily be different.

I was surprised if not shocked, however, to discover when I arrived that of the 14 students, I was the only one who was mentally ill. There were fathers, mothers, daughters, and sons of mentally ill people, but not mentally ill people themselves. Except for me.

At that point, I became very concerned that I had overlooked some obvious point. Why was it that I was the only mentally ill person there? What did all of the other mentally ill people know that I didn’t? Why weren’t they here with me? And so I gave it serious thought to leaving.

Seriously considering abandoning my mission before I even began, I explained my concerns to my trainer, Kate. Together, we faced every one of my concerns head-on, leaving nothing left unsaid or unexplored.

I was worried about how well I would take listening to all of the pain and suffering the mentally ill person (like me) managed to inflict on family members (like them) who would be showing up for the support groups.

I was concerned that family members (like them) might be afraid to really share their feelings with the support group after they learned that mentally ill people (like me) might be present. We worked through each of these issues, and ultimately she told me that the decision of whether to stay or go was mine.

Making the decision easier in some respects and harder in others was the fact that my roommate for the weekend just happened to be a licensed mental health counselor who just happened to know my sister, also a licensed mental health counselor.  As anyone experiencing any sort of emotional trauma can tell you, life with a professional counselor is much, much better than life without one. It’s like having a heart attack when your neighbor is a heart surgeon. A good place to be ill, in other words.

Ultimately, after much thought, I decided to stay, with the caveat that if I became uncomfortable I was going to just get up and leave without any fanfare.  Giving me her business card, Kate asked me to call her right away if I suddenly bolted, just to make sure that I was in an emotional state that allowed me to drive myself home. I agreed to her request. Fortunately, it never came to that.  Surprising myself, I stayed for the entire training.

In retrospect, I probably shouldn’t have been there. But I’m glad that I was.

A Journey Into Madness January 21, 2010

Posted by Crazy Mermaid in Delusions, Hallucinations, mental illness.
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A journey into madness begins with the first step. It isn’t a case where you wake up one morning and say to yourself Oh, no! I’ve lost my mind!”  Rather, it’s more like someone who gains say 25 pounds over the course of one year.  It’s a very gradual thing.  One pound. Then a leveling off for a few weeks. Then another pound.  Then a pound two weeks after that. And so on.

The same with mental illness. One small step towards madness the first day. Maybe you think you can communicate with one person via ESP.  And then a leveling off for a little while, as that small step (communicating with one person via ESP) becomes the new “normal”.  Then a few days later, another person is added to the ESP repertoire. Day after day, another person or two is added to the number of people you communicate with via ESP. Then you start seeing green people. Then zombies. Day after day these small steps play out little by little.  Step upon step, all becoming the next “normal”.  It’s not like a heart attack where you wake up and your world changed overnight.  It’s more like Alzheimer’s or Parkinson’s or some other relatively slow-moving disease where your world changes slowly but surely.

But I won’t kid you here.  The progression of my illness wasn’t in years. It was in months.   I went from being a relatively sane 49 year old professional woman (with no history of mental illness or drug or alcohol use) the first week in February 2008 to involuntary committment to a mental hospital with a full-blown case of Bipolar I with psychotic tendencies at the very end of May 2008. Almost four months from start to finish.

That would seem relatively quickly to some, but again think of weight gain.  You don’t feel every single pound of weight gain on a day to day basis. You don’t feel every single daily aspect of the loss of memory that’s the hallmark of Alzheimer’s. One little change at a time, piled upon the other little changes. And so it goes for insanity.

Mental Illness and Weight Gain January 14, 2010

Posted by Crazy Mermaid in Hearing Voices, Weight Gain and Mental Illness, mental illness.
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Fat Fat Fat

Getting enough meds in me to keep sane and yet relatively un-blimpo is quite a balancing act.

Most mood stabilizers and antipsychotics are well-known weight gain drugs.  The “big names” like Lithium, Lamictal, Risperdol, and Seroquel are all famous weight gainers.  I was on three out of four.

Because I was on major quantities of Lithium (900 mg) while at the hospital for my three week “vacation”,  Dr. K, my new (at the time) psychiatrist,  went to work on the weight gaining aspect of my medications immediately after I left the hospital, weaning me off the massive quantities of Lithium and onto Geodon, the only anti-psychotic that doesn’t cause weight gain.  The process took months to accomplish.  Because I had to be relatively stable in order to accomplish the switch, the process took longer than it “should” have, having to arrange itself around my various “falling-down” eposides.  Saying the progress was not uniform is an understatement. There would be forward progress,  then an incident that caused back-peddling, then forward progress, then backpeddling. Back and forth for months and months, until finally, *we got entirely on the Geodon. All was well for several months.

But about 6 months into the “complete” Geodon  regimen, I heard what we called “break-through voices”, which means in layman’s language that the Geodon failed to work.  So Geodon was out.  And Lithium, though very effective for voices, has too many terrible side effects, so we didn’t want to return to that, although there was no doubt that it would have gotten rid of the voices. That left some brand new drugs with fewer side effects, but those newer drugs had price tags in the $500 a month and up range (all out-of-pocket), so my husband and I decided that they were out for financial reasons.  That left Risperdol, which was an older, effective, but weight-gaining, drug.

So I was weaned off the Geodon and onto the Risperdol, which took  time. You don’t just suddenly stop taking one drug and get the effects out of your body immediately or start taking one drug and get it up to full strength immediately.  Most mental illness drugs don’t work like that.  It took several months for the Risperdol to build up enough in my system so that we could begin reducing the level of Geodon. Again, there would be backsliding while the switch was being made.  Finally, over a period of months, I was weaned entirely off the Geodon and entirely onto the Risperdol. Then it was a matter of finding out whether the Risperdol was going to work.  That was a matter of watching and waiting. Or in my case listening.

For months, the Risperdol worked just fine.  It worked so well, in fact, that we were able to reduce my dose from 1 mg down to .5 mg, and then to .25 mg, with the intent of eliminating the drug altogether in the relatively near future.   But before that could be accomplished, I had a little “bump in the road” incident a few months ago. So instead of discontinuing the drug as planned, we raised it back up to .5 mg. That was supposed to be a temporary thing.

Before we could lower the dose back to .25 mg, I had a major setback about a month ago.  Suffice it to say that the voices came back so strongly that it was back to the Haldol  (the nastiest drug in the universe)  as we contemplated a return to the mental hospital. That’s how bad the symptoms were.  (Note: There was a major trigger to the incident, so it wasn’t that the drug was failing. It was that the trigger was too strong).  But as Dr. K and I talked it over, we decided that instead of continuing on Haldol (which I despise) or hospitalization, we would triple my dose of Risperdol and see if that worked before trying hospitalization or more Haldol.   So I went from .5 mg to 1.5 mg virtually overnight.  As it built up in my system the past four weeks, the voices have gotten quieter and quieter, finally tapering off entirely about a week or so ago.  That’s all to the good. But there’s a down side to the Risperdol:  Weight gain.

Until my Risperdol was tripled, I had come to relative terms with my appetite, despite the fact that I was on all of those other weight-gaining meds, including Seroquel, Lamictal, and a smaller dose of Risperdol.   I was taking Welbutrin in an effort to combat some of those pesky appetite-increasing side effects, and it was working fairly well.  But then the triple dose of Risperdol kicked in, and I gained about 4 lb in about 4 weeks. Not good.  I saw Dr. K yesterday, and I told him how out of control my appetite is. I can’t stop thinking about food food food. When’s my next meal? How much can I eat? How many calories have I had already? And on and on and on every second of every minute of every day.  He was concerned, as am I.  Concerned enough that we brainstormed solutions.  I talked about how well phen/fen worked for me back in the mid 1990’s.  He doesn’t like SSRI’s for me because they might flip me to mania, so we settled on Topamax, at least for now. So now, we’ve added Topamax to the mix in an effort to get the weight gain under control.

Dr. K’s not thrilled about adding another drug to the mix (this will be #5), and yet we’re caught between a rock and a hard place. Trying to reduce the Risperdol and/or the other meds invites a return of the voices in full force.  Leaving the drug levels as is tips the scales to diabetes and all of the problems it entails.  So it all comes down to this: which is the lesser of two evils:  Voices or substantial weight gain?

In the end, we decided that adding that 5th  med is better than risking diabetes. So that’s the way we’re going.  The caveat is that instead of seeing me in 6 to 8 weeks, he’s seeing me in 2 weeks.  We’ll see how we do.

* I use the term “we” because Dr. K and I work together as a team. It’s not just “I” or “Him”. It’s “us” and “we”.  It’s been that way from the very beginning almost 2 years ago. I consider myself very, very fortunate.

HIPAA Laws: Unintended Consequences January 10, 2010

Posted by Crazy Mermaid in HIPAA Laws, Involuntary Committment, Mental Hospital, mental illness.
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Anyone whose loved one suffers from severe mental illness has most likely run smack dab into the HIPAA laws when they try to help their loved one. The way they stand right now, HIPAA Laws (Health Insurance Portability and Accountability Act of 1996) are a hindrance rather than a help for the severely mentally ill population.

While researching this article, I tracked down the original source of the HIPAA laws. For those of you interested in doing your own research, the HIPAA Law is spelled out in its entirely in CFR (Code of Federal Regulations).  Specifically, Title 45- Public Welfare Subtitle A Department of Health and Human Services Part 164 Subpart E Privacy of Individually Identifiable Health Information Section 164.506 through 164.512, Page 750 through 753.  It’s all legalese.

But the bottom line is that Section 164.506 (b) says: A covered entity (Hospital or Medical Clinic) may obtain consent of the individual to use or disclose protected health information to carry out treatment, payment, or health care operations. That, my friends, is the paragraph barring the friends and family of a mentally ill person from acting as the patient’s advocate.  Note the wording doesn’t say “must”. It says “may”.  But in order to cover their asses from lawsuits from patients claiming they didn’t consent to divulging medical information to a particular family member or friend, medical facilities choose to turn the word “may” into the word “must”.  Therein lie the problems.

While the goals of the HIPAA law are admirable, the HIPAA law needs to change when a person is diagnosed with a serious mental illness. This is especially true when a mentally ill person is hospitalized, either voluntarily or involuntarily, in a mental hospital. As the law stands now, the unintended consequences are that the HIPAA Laws work against mentally ill people, preventing them from obtaining advocacy and help in a time of critical need.

Here’s the rub:  The State of Washington has the power to remove my civil rights in order to treat me. But this same entity, thought stripping me of my civil rights, does not allow my husband to step in as my advocate because HIPPA laws prevent it.

It’s important to note that one of the criteria for diagnosis of mental illness is the presence of crippling paranoia, delusions, hallucinations, or a combination thereof. Symptoms so bad, in fact, that the State has to step in and take the step of stripping the patient of civil rights, in order to commit the individual to a mental hospital for an unspecified period of time.  The State gives that hospital the task of pumping the patient full of medication designed to bring about the return of the patient’s reasoning ability.

But the second the patient is committed, the HIPAA laws kick in. The patient is supposedly sick enough to require hospitalization for a chemical imbalance of the brain, stripped of his civil right to forego treatment for his illness, but this same patient, stripped of his civil rights, somehow (according to the HIPAA Laws) retains the right of privacy afforded by the HIPAA laws. The bottom line is that the State selectively decides which rights to strip the patient of and which rights to allow the patient to keep. They make the absolute worst value judgment in the history of humankind: the State assumes that a patient who loses his mind to the point that he has to be committed to a mental hospital has somehow retained the ability to advocate for himself. That patient, stripped of his civil rights and without an advocate, is left at the mercy of the hospital personnel, who don’t necessarily have the patient’s best interests at stake in their decision-making process. The patient is left vulnerable, the paranoia freezing out all other thought. And with their civil rights stripped and an ill brain, the patient’s supposed to be able to make rational decisions and act as their own advocate? Yeah right.

Involuntarily Committed to Mental Hospital January 6, 2010

Posted by Crazy Mermaid in Involuntary Committment, Psych Ward, Psychotic, mental illness.
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My husband knew that something was the matter, but had no clue what it was or the magnitude of the problem. He got a few glimpses here and there, like when I wrote a $55K hot check for a brand new Lexus, spent thousands of dollars on plants and flashy trashy new clothes, and started wearing garish makeup (ringing my eyes with a gold makeup crayon).  Or when I quit my job (managing a $55 million construction project and making over $100K a year) out of the blue. He knew that I wasn’t doing drugs or drinking, but still- something was very, very wrong.

I finally reached the flashpoint where I realized I could no longer tell reality from fantasy when I encountered an infestation of zombies at my neighborhood (YMCA) swimming pool. Dripping wet and still in my swimming suit, I drove myself home.  Scared to death, I begged my husband to take me to the emergency room after I told him I was hearing voices.  He didn’t ask, and I didn’t tell him, the nature of the voices or how long I’d been hearing them (3 1/2 months). He was just thankful that I had finally admitted to him that there was something wrong.

Once we arrived at the Hospital emergency room, I immediately changed my mind about wanting to be there.  Actually, the voices changed my mind for me.  At their direction, I tried to leave, but my husband cornered me like I was a calf at a rodeo. Finally, after taking off all my clothes in the women’s restroom (at the direction of the voices) and parading around naked in the waiting room (and refusing to put them back on or wear a blanket), as well as several escape attempts, I was put in a locked private room, alone except for a talking blood pressure machine, six imaginary people talking to me in my head, and an imaginary tree person drawing leaves and branches on the white walls.

They could guess, but they didn’t know, that I was having delusions, but they could never have guessed at the magnitude of the problem. In the meantime, the staff wouldn’t let me leave the locked room or tell me what was going on. I knew they couldn’t legally hold me, but they were doing it anyway.   I felt powerless. I believed they were trying to kill me by radiation so they could drop my dead body on Iraq as a weapon ( but I didn’t let them know that).  In frustration, I (at the direction of my lawyer, who was one of the voices in my head) threw a stool at the door, trying to break the little glass window in the door so I could leave. I was unsuccessful, only managing to make a few dents in the drywall around the door.

At the point I threw the stool, I unknowingly entered a new realm of law: involuntary commitment. I had crossed a line, demonstrating in concrete terms that I had become a danger to myself and others, and demonstrating to the hospital personnel that I needed evaluation by an independent (outside the employ of the hospital) licensed mental health professional to determine whether I had to be involuntarily committed to a mental hospital. The Hospital was required by the laws of the State of Washington to have a designated mental health professional interview me once the stool hit the wall.  Up until that point, the hospital would have interviewed me without the intervention of the mental health professional, and they would most likely have released me, because there aren’t enough (mental) hospital beds to handle all of the people who need care.

Telling everyone within hearing range that I was a mermaid, walking around the waiting room showing people my feet and asking them if they could see my fins, and even taking off my clothes didn’t demonstrate to anyone that I was a danger as defined by the State of Washington laws. Mermaids aren’t harmful, and believing you’re a mermaid isn’t against the law.  Even taking your clothes off in public doesn’t automatically qualify you as a danger. But throwing the stool changed everything. It gave the State the authority  to lock me up in a mental hospital. Once there, the mental hospital legally* held me against my will for 120 hours before they went before a judge to get a court order to hold me involuntarily up to 2 weeks.  Before the two weeks was up, they had to again go before a judge to continue holding me beyond that 2 weeks.  The second court order allowed them to hold me up to 90 days, but they only held me one week longer. I was out in 3 weeks.

*Note: By State of Washington law, the mental hospital can only hold a patient 72 hours before they have to go to court to get a court order. But that excludes weekends and holidays, which is why I was held 120 hours.

Waking Up in a Mental Hospital Psych Ward January 6, 2010

Posted by Crazy Mermaid in Involuntary Committment, Psych Ward, Psychotic, mental illness.
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I awoke laying on the bed, covered by a sheet and a light yellow blanket. There wasn’t a soul around.   I had no idea where I was or what I was doing there. The last thing I remembered was being wrestled and pinned onto a red four-point restraining board at the hospital emergency room and then being strapped in and  shot up with some kind of drug. After that, I didn’t remember a thing. I didn’t know what day it was, or what time of the day it was.  I had no purse, no money, no identification.  No bra, no underwear, no shoes, no pants, no shirt.  Nothing but my hospital gown.  And my voices and delusions.

My rights had been taken away from me, for no reason.  I was a prisoner and I hadn’t even had a trial. I couldn’t go anywhere.  I couldn’t leave the locked room with the furniture bolted to the floor.  Even if I were allowed to leave, I had no clothes, no shoes, and no money.

Someone asked me later on if I was scared at that point. No, I wasn’t scared.  I was angry. No, I take that back. WE were angry.  All of my voices and I were very, very angry. We couldn’t get over the fact that wherever I was, I was being held against my will. I was being treated as if I had no rights.

I don’t remember exactly when I learned that I had been involuntarily committed to the psychiatric ward of a mental hospital. But I do remember that I simply couldn’t wrap my brain around the fact that in this day and age I could be whisked away illegally from my home and locked in a room with nothing but a bed bolted to the floor. I couldn’t believe it!  I was in shock.

It turned out to be the morning of the 29th of May 2008.  It had been 24 hours since I had entered a hospital Emergency Room.

Note: Under the laws of Washington State, the mental hospital could hold me for up to 72 hours against my will without having to undergo any legal proceedings.